Automatic–self-acting under conditions fixed for it; having the power of action within it

For decades, pacemakers have possessed automatic features, many of which are now taken for granted. Without automation, the pacemaker would be restricted to fixed rate asynchronous output. The earliest automated pacemaker function was the introduction of the inhibited output mode in the early 1960s.<sup>28 Hidefjall P. The Pace of Innovation: Patterns of Innovation in the Cardiac Pacemaker Industry  Motala: Kanaltryckeriet I Motala AB (1997).  127-268

Cliccare qui per andare alla sezione Riferimenti</sup> These early implementations of automation are now considered fundamental pacemaker functions, but in the late 1960s even the need for a noncompetitive pacing mode was hotly debated. Over the next two decades, further automation of pacemaker function gradually progressed to include features such as physiologic DDD pacing, pacemaker mediated tachycardia (PMT) intervention, rate adaptive pacing and mode switching. These early automated functions were largely confined to adjustments in the timing cycle of the devices. A brief chronology of the evolution of automated pacemaker operation is shown in Figure 1.

Within the past decade, virtually all aspects of pacemaker operation have been subjected to automated control.<sup>30 Jones B.R., Kim J., Zhu Q. , e al. Future of bradyarrhythmia therapy systems: Automaticity Am J Cardiol 1999 ;  83 : 192D-201D  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 48 Saoudi N., Appl U., Anselme F. , e al. How smart should pacemakers be? Am J Cardiol 1999 ;  83 : 180D-186D  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> These functions now include automatic capture and sensing control, self-adjusting rate response settings, sinus rhythm and atrioventricular (AV) conduction preference, and automated implant algorithms. A list of currently automated pacemaker functions is shown in Box 1.

The automation of pacemaker function is a rapidly growing trend in the pacing industry. Advanced automation has many potential benefits and has great appeal to clinicians. Critical evaluation of many new functions is lacking, however, and in most cases the actual clinical benefits of these advanced technologies have not been demonstrated. This article reviews the operation of newer automated pacemaker functions and describes their potential benefits and disadvantages.