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Available evidence supports the hypothesis that CRT results in favourable structural and electrical remodeling. Whether this effect would obviate the need for back-up defibrillation capability in CRT devices is unclear and should be the focus of further studies.

In the present animal model study, the pacemaker Sophós 100 proved fully reliable in a 1 month follow-up period. TVI sensor operation did not interfere with conventional pacemaker functions, opening the way to its implantation in human beings.

The advent of digital technology in implantable cardiac stimulators will open up new frontiers for the automatic analysis and diagnosis of endocardial signals. This will dramatically increase the reliability of the therapies delivered and the amount of information that can be processed and stored for clinical and scientific purposes. In the next few years, we can expect specific algorithms to be developed for morphological discrimination of the farfield R-wave in the atrium and the retrograde P-wave. The use of blanking periods will gradually be phased out, since the system will instantly classify what it receives from the implanted electrodes, without needing to mask undesired signals. Such devices w ill really and continuously monitor every cardiac event.

Upon completion of the chapter, the student will be able to:

Patients with right ventricular pacing and heart failure may be candidates for resynchronisation therapy with the upgrading to biventricular pacing.

The procedure has been shown to be simple and safe. In addition, the results of the above-mentioned studies are encouraging and show that upgraded patients may profit from a better quality of life. However, the life expectancy of these patients remains to be investigated.

There is a high and in many cases inappropriate use of ICDs in patients with long QT syndrome with syncope. The pros and cons of the ICD and of the other available therapies should be clearly explained to all patients before recommending one or another.

It should be remembered that LQTS is profoundly different from most of the more prevalent conditions for which an ICD is usually recommended, and that among the special features of LQTS the tight relationship between release of catecholamines and life-threatening arrhythmias is an important one capable of initiating storms of shocks.

The wise use of the ICD in LQTS can save many lives. The unwise use of the ICD in LQTS can ruin many lives. A competent and caring physician should not be unmindful of his/her complex responsibilities toward the - usually young - LQTS patients.

In the present animal model study, the pacemaker Sophós 100 proved fully reliable in a 1 month follow-up period. TVI sensor operation did not interfere with conventional pacemaker functions, opening the way to its implantation in human beings.

The advent of digital technology in implantable cardiac stimulators will open up new frontiers for the automatic analysis and diagnosis of endocardial signals. This will dramatically increase the reliability of the therapies delivered and the amount of information that can be processed and stored for clinical and scientific purposes. In the next few years, we can expect specific algorithms to be developed for morphological discrimination of the farfield R-wave in the atrium and the retrograde P-wave. The use of blanking periods will gradually be phased out, since the system will instantly classify what it receives from the implanted electrodes, without needing to mask undesired signals. Such devices w ill really and continuously monitor every cardiac event.

In summary, the SMU is uncommon in North America. Furthermore, relatively few arrhythmia specialty centres are contemplating establishment of such a facility, although most survey respondents believe that an SMU would be helpful. The survey findings suggest that establishment of such a unit is impeded by lack of leadership, resource limitations within medical centres, and absence of convincing published data regarding SMU effectiveness. Thus, at least in the near term, the SMU will remain the exception rather than the rule in North American medical practice.