Pacemaker therapy is a cornerstone of modern electrophysiology, providing life-saving rhythm support for patients with bradyarrhythmias, AV block, chronotropic incompetence and conduction-system disorders. Contemporary pacemakers offer sophisticated sensing, pacing algorithms, remote monitoring capabilities and long-term reliability. As technologies advance rapidly—from traditional transvenous systems to leadless devices—clinicians turn to expert-driven cardiology conference sessions to explore evolving implantation techniques, device programming and patient-specific optimisation strategies. With its relevance to cardiac pacing innovations, this session focuses on the expanding role of pacemakers in rhythm management and long-term cardiac care.

The session begins by examining key indications for pacemaker therapy, including sinus node dysfunction, high-grade AV block, postoperative conduction delay and neuromuscular conditions affecting conduction. Attendees review clinical evaluation, ECG interpretation and electrophysiological findings that determine ideal candidates for pacing.

Implantation techniques are discussed in detail, including venous access strategies, lead positioning in the right atrium or ventricle, and considerations for avoiding phrenic nerve stimulation, lead dislodgment or venous complications. The emerging role of leadless pacemakers is explored, highlighting benefits such as reduced infection risk, shorter procedure time and applicability in patients with limited venous access.

Device programming forms a major component of this session. Participants learn how to adjust sensing thresholds, AV timing, rate-adaptive algorithms and mode switching to optimise synchrony, reduce unnecessary pacing and improve battery longevity. Case examples demonstrate how tailored programming improves symptoms and exercise tolerance.

Pacemaker follow-up is equally important. The programme outlines remote monitoring capabilities, early detection of arrhythmias, lead alerts, battery trends and diagnostics that support proactive care. Long-term issues such as lead failure, infection, pacemaker-mediated tachycardia and pacing-induced cardiomyopathy are discussed with structured management strategies.

Future developments include conduction-system pacing, His-bundle pacing, left bundle area pacing, miniaturised devices, enhanced remote monitoring and integration with artificial intelligence. These innovations promise more physiological pacing and improved longevity and safety.