Biological Pacing—Still Coming: But How? When? Where?

Electronic pacing has been the state-of-the-art therapy for complete heart block since the 1960s and, since then, has achieved an enviable therapeutic record in a number of additional settings. Electronic pacing still represents, however, an invasive technology necessitating the implantation of hardware and has various attendant shortcomings. This has led to the search for a biological alternative that might restore normal rhythm to the heart by manipulating or augmenting the function of endogenous cardiac cells. The past 15 years have seen myriad approaches, nearly all of which depend on variations in gene and/or cell therapy. In this lecture, Dr. Michael Rosen will consider the promise, progress, and pitfalls of these approaches.