The Cutting Edge of Cardiac Pacing, Electrophysiology and Diagnostic Techniques

Dear Colleagues,

From the first implantable pacemaker developed in the 1950s by Dr. Wilson Greatbatch, technologies and therapies have evolved rapidly in the field of electrophysiology and cardiac pacing, particularly with the aim of improving quality of life and life expectancy by using even more minimally invasive techniques. Implantable cardioverter defibrillators (ICDs) have clearly established a proven benefit in reducing the risk of sudden cardiac death in patients affected by advanced heart failure or genetic diseases. Novel extravascular ICDs ensure the same benefits as transvenous ones but at the cost of a significantly reduced rate of complications, with subsequent fewer negative implications, especially in young patients. Resynchronization therapy is the cornerstone of the heart failure armamentarium, with even more well-tested technologies and possible fields of employment, in particular regarding conduction system pacing. Leadless pacemakers represent the most significant innovation in cardiac pacing technology, avoiding leads, surgical wounds, infections and battery replacement. On the other hand, catheter ablation is currently capable of treating 100% of cardiac arrhythmias, although with variable results. The advent of three-dimensional (3D) mapping systems has completely overturned electrophysiological techniques by providing detailed anatomical and electrical information of the heart, allowing for precise localization of arrhythmogenic substrates and targeted ablation. Innovations in catheter design, such as the development of irrigated-tip catheters and contact force-sensing catheters, have improved procedural efficacy and safety. The integration of advanced imaging modalities, such as magnetic resonance imaging (MRI), computed tomography (CT) and intracardiac echocardiography (ICE), with mapping systems has improved procedural planning and visualization. New developments will undoubtedly become available that will eliminate human error through the increasing use of automation and robotics in such procedures. Cardiac electrophysiology is one of the fields that has seen the strongest scientific and technical developments over recent decades, capable of effectively treating patients who were deemed impossible cases a few years ago. The need for more complex therapies is further increased by the ageing population.

Dr. Fabrizio Guarracini
Dr. Patrizio Mazzone
Guest Editors

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• cardiac pacing
• electrophysiology
• abnormal heart rhythms
• rhythm abnormalities
• ablation
• atrial fibrillation
• cardioverter defibrillator (ICD) devices
• diagnostic devices