Temporary Pacing for Electric Cardiac Stimulation and Neuromodulatory Cardiovascular Therapy.

Abstract

The widespread prevalence and significant consequences of cardiac arrhythmias have been addressed by adopting cardiac stimulation and neuromodulation implantable devices. The oldest, most commonly employed, and most well-known technology is the permanent transvenous cardiac pacemaker. However, in select emergent clinical scenarios and transient pathologies, temporary pacing is preferred. More recently, neuromodulatory vagal nerve stimulation has emerged to address neurologic, psychiatric, and nociceptive pathologies, generating significant clinical and scientific interest in the invention of temporary corollary devices for a subset of indications of nociceptive origin. The dominance of particular implant approaches and anatomic targets in both temporary pacing and neuromodulation in the clinic is owed to capabilities and limitations present in the current technological landscape. However, recent innovations in industry and academia may lead to a fundamental shift in how temporary pacing and neuromodulation are delivered in terms of procedural approach and patient outcomes. In this review, we present an overview of contemporary temporary pacemakers, neuromodulatory therapies, and devices, highlighting novel temporary pacing technologies from the clinic, industry, and academia, such as temporary permanent pacemakers, innovations in non-blood-contacting devices, bioresorbable pacemakers, and advances in neuromodulatory approaches.