biological pacemaker

Science 18 July 2014: 
Vol. 345 no. 6194 pp. 268-269 
DOI: 10.1126/science.1257976

• PERSPECTIVE

TRANSLATIONAL MEDICINE

Improving cardiac rhythm with a biological pacemaker

1. Nikhil V. Munshi1,2,3, 
2. Eric N. Olson3,4

+Author Affiliations

1. ¹Department of Internal Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390, USA.
2. ²McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX 75390, USA.
3. ³Department of Molecular Biology, UT Southwestern Medical Center, Dallas, TX 75390, USA.
4. ⁴Center for Regenerative Science and Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA.

1. E-mail: nikhil.munshi@utsouthwestern.edu; eric.olson@utsouthwestern.edu

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.

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