How smart should pacemakers be?

The concept of the "smart" pacemaker has been continuously changing during 40 years of progress in technology. When we talk today about smart pacemake rs, it means optimal treatment, diagnosis, and follow-up for patients fitti ng the current indications for pacemakers. So what is smart today becomes a ccepted as "state of the art" tomorrow. Originally, implantable pacemakers were developed to save lives from prolonged episodes of bradycardia and/or complete heart block. Now, in addition, they improve quality of life via nu merous different functions acting under specific conditions, thanks to the introduction of microprocessors. The devices have become smaller, with the miniaturization of the electrical components, without compromising longevit y. Nevertheless, there are still some unmatched objectives for these device s, for example, the optimization of cardiac output and the management of at rial arrhythmias in dual-chamber devices. Furthermore, indications continue to evolve, which in turn require new, additional functions. These function s are often very complex, necessitating computerized programming to simplif y application. In addition, the follow-up of these devices is time-consumin g, as appropriate system performance has to be regularly monitored. A great many of these functions could be automatically performed and documented, t hus enabling physicians and paramedical staff to avoid losing time with rou tine control procedures. In addition, modem pacemakers offer extensive diag nostic functions to help diagnose patient symptoms and pacemaker system pro blems. Different types of data are available, and their presentation differ s from one company to the other. This huge amount of data can only be manag ed with automatic diagnostic functions. Thus, the smart pacemaker of the ne ar future should offer high flexibility to permit easy programming of avail able therapies and follow-up, and extensive, easily comprehensible diagnost ic functions. (C) 1999 by Excerpta Medica, Inc.