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Pacemakers and defibrillators: recent and ongoing studies that impact the elderly.

Since the first implantation of a cardiac pacemaker in the second half of the 20th century, there have been evolutionary and revolutionary advances in the technology developed for patients with heart rhythm disturbances. These advances, however, have instead failed to demonstrate that mimicry of physiology by a pacing system would deliver a longer and better life to its recipient. Indeed, we are just now in the process of developing a new paradigm in pacing that may finally deliver physiology to the hyperbolically named "physiologic pacing." This article will discuss the reasons for the discrepancy between the earlier studies and the more recent ones, as well as a review of implantable cardioverter-defibrillator trials, keeping in focus the special needs of aged heart rhythm device recipients.