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.