Advances in Physiologic Pacing

      As our island of knowledge grows, so does the shore of our ignorance.—John Archibald Wheeler, twentieth century physicist
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      Ranjan K. Thakur, MD, MPH, MBA, FHRS, Consulting Editor
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      Andrea Natale, MD, FACC, FHRS, Consulting Editor
      We are pleased to introduce this issue of the Cardiac Electrophysiology Clinics focused on advances in physiologic pacing, but we are also saddened by the unexpected and sudden demise of one of the coeditors, Dr Santosh Padala. Quite appropriately, the other two coeditors, Dr Kenneth Ellenbogen and Dr Pugazhendhi Vijayaraman, have memorialized this issue by dedicating it to their promising, young colleague. We offer our heartfelt condolences to Dr Padala’s colleagues and young family.
      Since the advent of ventricular pacing in the 1950s, it soon became clear that while this was a life-saving therapy, it was nonphysiologic and left much room for advancements. Physiologic cardiac pacing has been the paragon we’ve been seeking since the advent of pacing more than 60 years ago. These advances required improvement in our understanding of physiology of cardiac pacing and technical advances developed by industry. There have been many advancements, such as dual chamber pacing, cardiac resynchronization, and most recently in ascendancy, conduction system pacing.
      Although His-bundle pacing was initially described by Dr Pramod Deshmukh 25 years ago, it took the electrophysiology community many years to realize its potential. Initially there were very few practitioners of His-bundle pacing due to its technical challenges. However, in the last decade, there has been a worldwide resurgence. This has led to excellent research and development of new concepts. One such example is the realization that the target pacing site may not be limited to the bundle of His, but also includes the proximal left bundle; hence, it may be more accurate to talk about conduction system pacing and not just His-bundle pacing.
      We congratulate the editors of this issue, which offers a contemporary perspective on a six-decades-old challenge. Like all issues in science, what’s new and unexplored today will become settled within a few years, for as our island of knowledge grows, so will the shore of our ignorance, and we will be revisiting future advances once again. In the meantime, we hope the readership will find the current issue helpful in furthering their understanding of the contemporary issues.