Role of regenerative medicine in arrhythmia

With few exceptions, the therapy of cardiac disease focuses on prevention or palliation; only rarely (as in some forms of congenital heart disease) is complete cure a realistic goal. Yet now there is greater promise of cure, deriving in part from attempts to revascularize the myocardium, generate new myocytes, and engineer novel functions into existing or newly generated cells. Among the strategies employed have been insertion of genes to replace those which are malfunctioning, and more recently creation of a cellular substrate to supplant abnormally functioning myocardium. There is less knowledge of the direct applicability of gene/cell therapy to arrhythmia prevention or termination. There have been at least two stimuli for designing and fabricating biological pacemakers: (1) the desire to improve on electronic pacemakers that are currently the state of the art for treating many rhythm disorders; (2) to use this paradigm as a template for developing other gene/cell-based antiarrhythmic therapies. Among gene therapy approaches, only If has provided evidence of stable idioventricular escape rhythms having physiologically acceptable rates as well as evidence of autonomic responsiveness. Testing of the other approaches with regard to these criteria is awaited

Keywords:

Fabricating biological pacemakers , Gene therapy , Cell therapy , Arrhythmia prevention