Will the symbiotic pacemaker, a self-powered cardiac implanted electronic device, be the next evolution in pacemaker technology?

The first permanent implanted pacemaker was successfully used in clinical practice in 1958. In the past 60 years, the development of pacemakers has been witnessed in clinical application [1]. Early pacemakers were large and cumbersome, and had a short battery life, providing only a single-chamber asynchronous pacing (VOO) pacing mode. In 1967, on-demand pacemakers with synchronous pacing (WI) mode just came out. The emergence of the first dual chamber pacemaker in 1977 symbolized the entry into the physiologic pacing era. In 1982, pacemakers began to provide rate adaptive functions. In this age of accelerating development in scientific technologies and clinical researches, pacemakers have evolved into implantable cardioverter-defibrillators for the treatment of sudden cardiac death and cardiac resynchronization therapy for chronic heart failure, instead of simply being an electronic device that treats bradycardia by pulsing the heart (Fig. 1)[2,3].