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Basic Science for the Clinical Electrophysiologist

Cardiac Pacing

From Biological to Electronic ... to Biological?

Michael R. Rosen, MD; Peter R. Brink, PhD; Ira S. Cohen, MD, PhD and Richard B. Robinson, PhD

From the Center for Molecular Therapeutics (M.R.R., I.S.C., R.B.R.) and Departments of Pharmacology (M.R.R., I.S.C., R.B.R.) and Pediatrics (M.R.R.), College of Physicians and Surgeons of Columbia University, New York, NY; and Institute for Molecular Cardiology (M.R.R., P.R.B., I.S.C.) and Department of Physiology and Biophysics (M.R.R., P.R.B., I.S.C.), Stony Brook University, Stony Brook, NY.

Correspondence to Michael R. Rosen, MD, Center for Molecular Therapeutics, Departments of Pharmacology and Pediatrics, College of Physicians and Surgeons of Columbia University, 630 W 168 St, PH 7 West-321, New York, NY 10032. E-mail mrr1{at}columbia.edu

The prevention and treatment of life-threatening bradyarrhythmias have been revolutionized in the last half century by electronic pacemakers. Because this represents a palliative therapy, attempts have begun to effect a cure with the novel tools of gene and cell therapy. Over time, the strategies used have coalesced to focus on achieving a stable and autonomically responsive cardiac rhythm in a setting that ultimately would require no implanted hardware. In this report, we review the history of the disease process being treated, approaches now in progress, and the demands that must be met if biological therapies are to be successful.

Key Words: atrioventricular block • cell therapy of bradyarrhythmias • gene therapy • gene therapy of bradyarrhythmias • hyperpolarization-activated, cyclic nucleotide-gated channels

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