Biological pacing is a disruptive technology that aims first to improve upon, then to supplement and, eventually, to replace electronic pacingBiological pacing utilizes the tools of gene and cell therapy to introduce pacemaker function to preselected regions of the heartGene therapy focuses on delivery via viral vectors; whereas cell therapy uses either mesenchymal stem cells as delivery systems or cells with sinoatrial node-like properties derived from pluripotent stem cellsProof-of-concept has been achieved in studies of large animals in complete heart block and, in some instances, sinoatrial node dysfunctionSubstantial barriers remain to be overcome before clinical trials of biological pacing can be begun, but the field is advancing steadily towards this goal
Attempts to diagnose heart rhythm disorders and to treat them with electrical therapy go back hundreds of years. In the latter half of the 20th century, electronic therapy came fully of age with the arrival of the electronic pacemaker. Advances in the field have been impressive and yet important shortcomings exist such that, during the past decade, investigators have focused on building an alternative therapy. This research has been facilitated by our understanding of the genetic determinants of ion channel function and the availability of gene and cell therapies. In the following pages, we review the major achievements in the field of biological pacing, using lessons learned from normal cardiac pacemaker tissues such as the sinoatrial node (SAN) to divine their potential application to a novel biological approach.
