PerspectiveTranslational Medicine

Improving cardiac rhythm with a biological pacemaker

Science  18 Jul 2014:
Vol. 345, Issue 6194, pp. 268-269
DOI: 10.1126/science.1257976

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Electronic device therapies, including implantable pacemakers and defibrillators, have revolutionized the management of cardiovascular disease (1). For example, patients with certain slow cardiac rhythms (bradycardia) can experience exercise intolerance, easy fatigability, or circulatory collapse. Given that currently available drugs cannot safely and sustainably elevate heart rate, the only proven treatment for symptomatic bradycardia is permanent pacemaker implantation. Contemporary electronic pacemakers have an extended battery life, contain leads that minimize inflammation and scarring, and possess advanced algorithms to contend with heart rate elevations during exercise. These features allow pacemakers to improve longevity and quality of life in patients who require them. But electronic pacemakers cannot recapitulate all aspects of the endogenous sinoatrial node, the dominant pacemaker in the uninjured heart. In this regard, a recent study by Hu et al. (2) demonstrates the feasibility of a somatic cell reprogramming strategy for creating a biological pacemaker in a large animal preclinical model, raising prospects for clinical translation.