The Present and Future
State-of-the-Art Review
Cardiac Pacemakers: Function, Troubleshooting, and Management: Part 1 of a 2-Part Series

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Abstract

Advances in cardiac surgery toward the mid-20th century created a need for an artificial means of stimulating the heart muscle. Initially developed as large external devices, technological advances resulted in miniaturization of electronic circuitry and eventually the development of totally implantable devices. These advances continue to date, with the recent introduction of leadless pacemakers. In this first part of a 2-part review, we describe indications, implant-related complications, basic function/programming, common pacemaker-related issues, and remote monitoring, which are relevant to the practicing cardiologist. We provide an overview of magnetic resonance imaging and perioperative management among patients with cardiac pacemakers.

Key Words

atrial fibrillation
bradycardia
cardiac pacing
heart conduction system
magnetic resonance imaging
tachycardia

Abbreviations and Acronyms

CIED
cardiac implantable electronic device
CS
coronary sinus
PMT
pacemaker-mediated tachycardia
PVARP
post-ventricular atrial refractory period
RV
right ventricle
TARP
total atrial refractory period

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Dr. Friedman has received research support from St. Jude Medical; and is a consultant and advisory board member for Medtronic and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.