Understanding How Cardiac Devices are Aiding in Treatment and Prevention of Heart Disease

Heart disease remains the world’s leading cause of death, claiming approximately 17.9 million lives annually (WHO, 2023). The landscape of cardiovascular care has been transformed by advanced cardiac devices from pacemakers and implantable cardioverter-defibrillators (ICDs) to ventricular assist devices (VADs) and cutting-edge wearable biosensors.

Cardiovascular disease (CVD) encompasses a broad spectrum of conditions, including coronary artery disease (CAD), heart failure, arrhythmias, valvular disease, and congenital heart defects. Despite remarkable advances in pharmacological therapy, lifestyle interventions, and surgical techniques, CVD continues to be responsible for roughly 32% of all global deaths, according to the World Health Organization (2023).

The economic burden is equally staggering. The American Heart Association estimates that the direct and indirect costs of CVD in the United States alone exceed $363 billion per year, a figure projected to reach $1.1 trillion by 2035. In low- and middle-income countries (LMICs), limited healthcare infrastructure compounds the problem, making cardiac devices all the more critical as scalable solutions.

Cardiac devices, broadly defined as implantable, wearable, or externally applied electromechanical instruments designed to monitor, support, or correct cardiac function, represent one of the most dynamic frontiers in modern medicine. From the first implantable pacemaker in 1958 to today’s AI-driven remote monitoring platforms, the evolution of these devices mirrors the broader trajectory of medical innovation.

Classification of Cardiac Devices

Cardiac devices are broadly classified into three primary categories based on their function and mode of delivery: implantable devices, wearable devices, and extracorporeal (external) support systems. Each category addresses different aspects of cardiovascular pathophysiology.

Implantable Cardiac Devices: Implantable cardiac devices are surgically placed within the patient’s body and are designed for long-term use. They include pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronisation therapy (CRT) devices, and implantable loop recorders (ILRs).

Wearable Cardiac Devices: Wearable devices operate externally and are rapidly gaining clinical acceptance. These include wearable cardioverter-defibrillators (WCDs), ambulatory ECG monitors, smartwatch-based cardiac sensors, and patch-based monitoring systems.

Extracorporeal & Mechanical Circulatory Support: These devices provide temporary or durable mechanical support to the failing heart, including intra-aortic balloon pumps (IABPs), ventricular assist devices (VADs), and total artificial hearts (TAHs).

Pacemakers: Regulating the Heart’s Electrical System

The cardiac pacemaker is arguably the most transformative cardiac device ever developed. First successfully implanted in a human by Åke Senning and Rune Elmqvist in Stockholm in 1958, modern pacemakers have undergone six decades of miniaturisation, programming sophistication, and remote connectivity.

Mechanism and Indications: Pacemakers deliver electrical impulses to the myocardium to stimulate contraction when the heart’s intrinsic electrical system fails. The primary indications include symptomatic bradycardia (resting heart rate <40 bpm with symptoms), sick sinus syndrome (SSS), high-degree atrioventricular (AV) block, and chronotropic incompetence.

Modern pacemakers are categorised by the number of leads: single-chamber (right ventricle or right atrium), dual-chamber (RA + RV), and biventricular devices used in cardiac resynchronisation therapy (CRT). The most recent innovation, the leadless pacemaker, is delivered entirely via catheter and sits within the right ventricle, eliminating the risk of lead-related complications.

Clinical Outcomes and Safety Data: A landmark multicentre study (MICRA Transcatheter Pacing Study, NEJM 2016) demonstrated that leadless pacemakers achieved successful pacing in 99.2% of 725 patients, with a major complication rate of 4%, significantly lower than conventional transvenous systems (6.7%). Long-term follow-up data at five years (published in JACC 2021) confirmed durable performance with a battery longevity of 10-12 years.

Key Pacemaker Statistics

• Approximately 1.25 million pacemakers are implanted worldwide each year (Medtech Europe, 2023).
• The global pacemaker market was valued at USD 5.11 billion in 2025 to reach USD 8.43 billion by 2034, growing at a CAGR of 5.81% during the forecast period from 2026 to 2034, according to DelveInsight’s analysis.
• Rate-adaptive pacing (RAAS) reduces hospitalisation by up to 22% in chronotropic incompetence patients.
• MRI-conditional pacemakers now account for over 70% of new implants in high-income countries.

The Medtronic Micra AV and Micra VR leadless pacemakers represent a paradigm shift in device therapy. At 1/10th the size of a conventional pacemaker and implanted entirely within the right ventricle, these devices eliminate pocket complications, lead fractures, and infection risks associated with conventional systems.

Implantable Cardioverter-Defibrillators (ICDs): Prevention of Sudden Cardiac Death

Sudden cardiac death (SCD), defined as an unexpected death from cardiac causes within one hour of symptom onset, claims an estimated 3.7 million lives globally each year (Lancet, 2022). The ICD, developed by Michel Mirowski and Morton Mower in the 1970s, stands as the single most effective intervention for the primary and secondary prevention of SCD.

How ICDs Work: An implantable cardioverter-defibrillator continuously monitors the cardiac rhythm. Upon detection of a life-threatening ventricular arrhythmia (ventricular tachycardia [VT] or ventricular fibrillation [VF]), the device delivers a precisely timed electrical shock (defibrillation) to restore normal sinus rhythm. Modern ICDs also provide anti-tachycardia pacing (ATP), a series of rapid, painless pacing pulses that can terminate VT without a shock, significantly improving patient quality of life.

Types of ICDs: Transvenous ICD (TV-ICD): The traditional gold-standard with leads placed through the subclavian vein into the heart. Subcutaneous ICD (S-ICD): Entirely extravascular system (Boston Scientific EMBLEM), ideal for young patients or those with venous access issues. Extravascular ICD (EV-ICD): A newer hybrid approach (Medtronic Aurora EV-ICD), offering ATP capability without intravascular leads.

Primary vs. Secondary Prevention: Secondary prevention ICDs are indicated for survivors of cardiac arrest or sustained VT. Primary prevention ICDs benefit patients with significantly reduced left ventricular ejection fraction (LVEF ≤35%) from cardiomyopathy or coronary artery disease, as established by landmark trials including MADIT-II (NEJM, 2002) and SCD-HeFT (NEJM, 2005).

Cardiac Resynchronisation Therapy (CRT): Healing the Dyssynchronous Heart

Heart failure with reduced ejection fraction (HFrEF) is often complicated by electrical conduction delays, most commonly left bundle branch block (LBBB), which cause the left and right ventricles to contract asynchronously. This dyssynchrony reduces cardiac output, promotes adverse remodelling, and worsens symptoms.

Cardiac resynchronisation therapy (CRT) employs a biventricular pacemaker to coordinate the contraction of both ventricles simultaneously through an additional left ventricular lead delivered via the coronary sinus. The result is dramatically improved stroke volume, reduced mitral regurgitation, and, over time, reverse myocardial remodelling.

Ventricular Assist Devices (VADs): Mechanical Support for the Failing Heart

When pharmacological and electrical therapies fail to adequately support the failing myocardium, mechanical circulatory support (MCS) in the form of ventricular assist devices (VADs) may be life-saving. VADs are electromechanical pumps that take over some or all of the pumping function of the left ventricle (LVAD), right ventricle (RVAD), or both (BiVAD).

Indications and Strategy: VAD therapy is deployed in three strategic contexts: Bridge to Transplantation (BTT), where the device maintains haemodynamic stability until a donor heart becomes available; Destination Therapy (DT), long-term permanent support for patients ineligible for transplantation; and Bridge to Recovery (BTR), temporary support allowing myocardial recovery in specific cardiomyopathies.

The HeartMate 3 (Current Gold Standard): The HeartMate 3 LVAD (Abbott) is a magnetically levitated centrifugal-flow pump that has redefined long-term MCS outcomes. The MOMENTUM 3 trial demonstrated that HeartMate 3 achieved a 2-year survival of 76.9%, superior to its predecessor HeartMate II, with dramatically lower rates of stroke, pump thrombosis, and re-operation.

Wearable Cardiac Technology: The Digital Revolution in Cardiology

The integration of consumer electronics with sophisticated biosensing technology has given rise to a new era of wearable cardiac monitoring. These devices empower patients and clinicians alike, enabling continuous, real-world cardiac data collection outside traditional healthcare settings.

Wearable Cardioverter-Defibrillators (WCDs): The wearable cardioverter-defibrillator (WCD), commercially represented by the ZOLL LifeVest, provides temporary protection against SCD in patients with elevated arrhythmia risk who are not yet candidates for an implantable ICD. Indications include newly diagnosed cardiomyopathy (LVEF ≤35%), post-myocardial infarction (90-day risk period), and post-cardiac surgery bridge periods.

Smartwatch and Consumer ECG Devices: The Apple Watch Series 4+ and subsequent generations incorporate single-lead ECG functionality using photoplethysmography (PPG) and electrical sensors. The Apple Heart Study (Perez et al., NEJM 2019) enrolled 419,297 participants, the largest clinical study using a consumer wearable, and demonstrated that irregular pulse notifications from the device had a positive predictive value of 84% for concurrent atrial fibrillation on ECG patch monitoring. 

Samsung Galaxy Watch and Fitbit Sense also offer atrial fibrillation detection algorithms with FDA clearance. Critically, the AliveCor KardiaMobile device, which attaches to smartphones, has been independently validated with sensitivity >90% and specificity >95% for AF detection, making it a Class IIa recommendation in current AF screening guidelines.

Implantable Loop Recorders (ILRs): For patients with infrequent or unexplained syncope, palpitations, or cryptogenic stroke (stroke of undetermined origin), the implantable loop recorder provides continuous subcutaneous ECG monitoring for up to three years. The Medtronic Reveal LINQ, measuring just 1.2 cc, the size of an AAA battery, is inserted subcutaneously via a minimally invasive injection system.

Remote Monitoring and Digital Health Integration

One of the most transformative developments in cardiac device therapy is the integration of remote monitoring (RM) capabilities. All major contemporary cardiac device platforms from Medtronic’s CareLink to Abbott’s Merlin.net, Boston Scientific’s LATITUDE, and Biotronik’s Home Monitoring, transmit device diagnostics wirelessly to secure cloud servers accessible by cardiologists in real time.

Clinical Impact of Remote Monitoring: The clinical impact of remote monitoring for cardiac devices has been substantial, improving patient outcomes, enhancing the efficiency of healthcare delivery, and enabling earlier detection of device- and disease-related complications. Remote monitoring systems integrated with cardiac implantable electronic devices (CIEDs), such as pacemakers, implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, and implantable loop recorders, allow clinicians to continuously track device performance and patients’ cardiac status without requiring frequent in-person visits. These systems can promptly identify arrhythmias, lead malfunctions, battery depletion, worsening heart failure, and other clinically significant events, enabling timely medical intervention before complications become severe. Numerous studies have demonstrated that remote monitoring is associated with reduced hospitalizations, shorter time to clinical decision-making, improved adherence to follow-up recommendations, and enhanced patient satisfaction. In patients with heart failure, remote monitoring of CRT devices can detect physiological changes suggestive of decompensation, allowing earlier therapeutic adjustments and potentially reducing emergency department visits and hospital admissions. 

Furthermore, the adoption of remote monitoring became increasingly important following the COVID-19 pandemic, as healthcare providers sought to minimize unnecessary hospital visits while maintaining continuity of care. As digital health technologies continue to evolve and reimbursement support expands, remote monitoring is becoming an integral component of modern cardiac care, improving clinical outcomes while optimizing resource utilization and supporting a more proactive and patient-centered approach to disease management.

Artificial Intelligence in Cardiac Device Analysis: Machine learning algorithms are being trained on millions of device electrograms to improve arrhythmia classification, reduce inappropriate ICD therapy, and predict adverse events. Medtronic’s AccuRhythm AI, embedded in the Reveal LINQ ICD, reduces false-positive AF detections by up to 60% through deep learning analysis of P-wave morphology and RR-interval variability.

Transcatheter Structural Heart Devices

Beyond electrophysiological devices, a revolution in structural heart disease treatment has been enabled by catheter-based interventional technologies that offer alternatives to open-heart surgery for high-risk patients.

Transcatheter Aortic Valve Implantation (TAVI/TAVR): Transcatheter Aortic Valve Implantation (TAVI), also known as Transcatheter Aortic Valve Replacement (TAVR), is a minimally invasive procedure used to treat severe symptomatic aortic stenosis by replacing the diseased aortic valve through a catheter, typically inserted via the femoral artery, without the need for open-heart surgery. The procedure is particularly beneficial for elderly patients and those at intermediate or high surgical risk, as it offers shorter recovery times, reduced hospital stays, and faster return to daily activities. 

Several leading medical device companies manufacture TAVI/TAVR systems, including SAPIEN 3™ and SAPIEN 3 Ultra™ by Edwards Lifesciences, Evolut™ FX and Evolut™ PRO+ by Medtronic, ACURATE neo2™ by Boston Scientific, and Navitor™ (formerly Portico™ platform) by Abbott. These transcatheter heart valves have revolutionized the treatment of aortic stenosis by providing an effective and less invasive alternative to surgical aortic valve replacement while delivering favorable clinical outcomes.

MitraClip and Transcatheter Mitral Valve Repair: MitraClip and Transcatheter Mitral Valve Repair (TMVR) are minimally invasive procedures used to treat mitral regurgitation (MR), a condition in which the mitral valve does not close properly, causing blood to leak backward into the left atrium. During the procedure, a catheter is advanced through the femoral vein to deliver a repair device that grasps and approximates the mitral valve leaflets, improving valve coaptation and reducing regurgitation without the need for open-heart surgery. These procedures are particularly beneficial for patients with symptomatic severe degenerative or functional mitral regurgitation who are considered at high or prohibitive surgical risk. 

The most widely used transcatheter mitral repair device is the MitraClip™ system manufactured by Abbott, including the latest MitraClip G4™ generation, which offers enhanced leaflet grasping and procedural flexibility. Other examples include the PASCAL Precision Repair System developed by Edwards Lifesciences, which provides an alternative edge-to-edge repair approach for patients with mitral regurgitation. These technologies have transformed the management of mitral valve disease by offering effective symptom relief, improved quality of life, and reduced hospitalization rates in patients unsuitable for conventional surgical repair.

Left Atrial Appendage Occlusion (LAAO): Left Atrial Appendage Occlusion (LAAO) is a minimally invasive procedure designed to reduce the risk of stroke in patients with non-valvular atrial fibrillation (AF) who are unsuitable for long-term oral anticoagulation therapy. The procedure involves delivering an occlusion device through a transcatheter approach, typically via the femoral vein and transseptal puncture, to seal the left atrial appendage, which is the primary site of thrombus formation in patients with atrial fibrillation. By preventing blood clots from entering the bloodstream and traveling to the brain, LAAO provides an effective alternative to chronic anticoagulant use. 

The most widely used LAAO device is the WATCHMAN™ FLX Pro manufactured by Boston Scientific, which is indicated for stroke risk reduction in patients with non-valvular atrial fibrillation. Another prominent example is the Amplatzer™ Amulet™ Left Atrial Appendage Occluder developed by Abbott, designed to achieve immediate appendage closure and provide an alternative treatment option for patients seeking to avoid long-term anticoagulation. These devices have significantly advanced the management of atrial fibrillation by reducing stroke risk while minimizing the bleeding complications associated with lifelong anticoagulant therapy.

Congenital Heart Disease and Paediatric Cardiac Devices

Congenital heart disease (CHD) affects approximately 1 in 100 live births, making it the most common birth defect globally. Cardiac devices play an increasingly vital role across the lifespan of CHD patients, from neonatal interventions to adult care.

Transcatheter closure of atrial septal defects (ASD), ventricular septal defects (VSD), and patent ductus arteriosus (PDA) using devices such as the Amplatzer Septal Occluder (Abbott) has largely replaced surgical repair for anatomically suitable defects, with closure success rates exceeding 98% and early discharge within 24 hours. Miniaturised pacemakers and ICDs adapted for paediatric use have improved long-term outcomes in children with congenital complete heart block and channelopathies such as long QT syndrome and Brugada syndrome.

Global Disparities in Cardiac Device Access

While cardiac device technology continues to advance at a rapid pace in high-income countries, access remains profoundly unequal globally. In low- and middle-income countries (LMICs), the cardiac device implantation rate is a fraction of that in developed nations,  a disparity driven by cost, infrastructure, trained personnel, and healthcare financing mechanisms.

The Cost Barrier: The total cost of a dual-chamber ICD implantation in the United States ranges from $30,000 to $60,000 (including device, leads, and procedure). In sub-Saharan Africa, where per-capita healthcare expenditure may be less than $100 per year, this represents an insurmountable barrier for the vast majority of patients. Generic and lower-cost device programmes, including Medtronic’s Healthy Heart for All initiative in India, have begun to address this through tiered pricing models.

Initiatives to Bridge the Gap

• World Heart Federation’s Emerging Economies Cardiac Devices Access Programme (2022)
• Medtronic Philanthropy: donated >50,000 pacemakers to 45 countries since 2000
• IACS (International Alliance for the Control of Schistosomiasis) cardiac health outreach in Africa
• Training programmes through the Pan-African Society of Cardiology (PASCAR) to build implantation expertise
• WHO’s Package of Essential Non-Communicable Disease (PEN) interventions,  limited integration of device therapy

Emerging Technologies and the Future of Cardiac Devices

The next decade promises unprecedented innovation in cardiac device technology, driven by advances in materials science, miniaturisation, wireless communication, artificial intelligence, and regenerative medicine.

Fully Dissolved (Bioresorbable) Cardiac Devices: Transient cardiac pacemakers fabricated from bioresorbable materials (polylactic acid, magnesium alloys, silicon nanomembranes) have been demonstrated in animal models at Northwestern University (Efimov et al., Nature Biotechnology 2021). These devices provide pacing for the critical post-operative period following cardiac surgery and then harmlessly dissolve within days to weeks, eliminating the need for lead extraction.

Wireless Charging and Battery-Free Devices: Research groups at MIT and Northwestern are developing wirelessly powered cardiac devices that harvest energy from ultrasonic waves transmitted through the thoracic wall, eliminating batteries. This technology could dramatically extend device longevity and reduce the physical footprint of implanted electronics.

AI-Driven Predictive Algorithms: Heart failure decompensation is frequently preceded by subtle haemodynamic changes detectable days before hospitalisation. The CardioMEMS HF System (Abbott), an implantable pulmonary artery pressure sensor, demonstrated in the CHAMPION trial (Abraham et al., Lancet 2011) a 37% reduction in HF hospitalisations by enabling proactive diuretic titration guided by remote pressure monitoring. Next-generation AI platforms will integrate CardioMEMS data with remote device diagnostics, biomarker trends, and activity monitoring to generate personalised, predictive alerts.

Gene Therapy and Biological Pacemakers: Biological pacemakers created by gene transfer of the HCN2/HCN4 hyperpolarization-activated cyclic nucleotide-gated channel genes into ventricular cardiomyocytes have demonstrated stable, autonomically responsive pacing in canine models for over a year (Boink et al., JACC 2020). If human trials confirm safety and efficacy, biological pacemakers could eventually replace implantable electronic devices for selected patients.

Nanotechnology and Theranostic Devices: Nano-biosensors capable of detecting cardiac troponin, BNP, and inflammatory cytokines in real time within the bloodstream represent the frontier of theranostic (therapeutic + diagnostic) cardiac technology. Embedded within stent platforms or standalone intravascular sensors, these nanodevices would enable instant molecular diagnostics and targeted drug delivery, a seamless fusion of pharmacology and device therapy.

Ethical, Legal, and Psychosocial Dimensions

Device Deactivation at End of Life: A critical and often under-discussed ethical dimension of cardiac device therapy concerns deactivation at the end of life. For patients with terminal illness or those choosing comfort-directed care, ICD therapy, particularly repeated defibrillation shocks, may constitute an unwanted, painful, and undignified intervention. International consensus statements (HRS/EHRA/APHRS 2010 Expert Consensus, updated 2022) affirm that patients have the legal and ethical right to request device deactivation, and that acceding to such requests is ethically distinct from assisted dying.

Data Privacy and Cybersecurity: The wireless connectivity of modern cardiac devices introduces a previously unimaginable security vector. Landmark research by Barnaby Jack (Black Hat conference, 2012) demonstrated that ICD systems could theoretically be hacked to deliver inappropriate shocks or disable therapy. Following public disclosure, the FDA issued comprehensive cybersecurity guidelines for medical device manufacturers in 2014, 2018, and most recently in 2023, requiring post-market vulnerability monitoring, coordinated disclosure, and software patching capabilities.

Simultaneously, the vast quantity of physiological data transmitted by cardiac devices raises significant privacy concerns. Device manufacturers and healthcare providers must adhere to HIPAA (USA), GDPR (EU), and equivalent national frameworks to ensure patient data sovereignty and prevent commercial exploitation of sensitive health information.

Quality of Life and Psychological Impact: Living with an implanted cardiac device profoundly affects psychological well-being and quality of life. ICD patients in particular report elevated rates of anxiety, particularly ICD shock anxiety, depression, and activity restriction. Studies indicate that 20–30% of ICD recipients meet clinical criteria for anxiety disorders, and approximately 15% develop frank depression. Psychological support, peer support groups, and dedicated cardiac device nurse specialists are integral components of comprehensive device care programmes.

Global Cardiac Devices Market Overview and Key Industry Players

The global cardiac (cardiovascular) devices market is a multi-billion-dollar industry characterised by continuous innovation, consolidation, and intense regulatory scrutiny. The global cardiovascular devices market was valued at USD 70 billion in 2025 and is projected to grow at a CAGR of 8.1% duriong the forecast period from 2026 to 2034 and reaching USD 139.4 billion by 2034. The global cardiac devices market is being driven by several factors, including the rising prevalence of cardiovascular diseases (CVDs), increasing adoption of minimally invasive cardiac procedures, growing aging populations, and continuous technological advancements in cardiac care. 

Cardiovascular diseases remain the leading cause of mortality worldwide, with conditions such as coronary artery disease, heart failure, atrial fibrillation, valvular heart disease, and cardiac arrest increasing the demand for devices such as pacemakers, implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, transcatheter heart valves, cardiac monitoring systems, and left atrial appendage occlusion devices. The growing preference for minimally invasive interventions, including Transcatheter Aortic Valve Replacement (TAVR), MitraClip procedures, and catheter-based electrophysiology treatments, is further accelerating market growth due to shorter hospital stays and faster patient recovery. 

In addition, advancements such as MRI-compatible implantable devices, leadless pacemakers, remote patient monitoring technologies, artificial intelligence-enabled diagnostics, and Bluetooth-connected cardiac devices are improving clinical outcomes and expanding adoption. Rising healthcare expenditure, improved reimbursement policies in developed countries, increasing awareness regarding early diagnosis and treatment of heart diseases, and expanding access to advanced cardiac care in emerging economies are also contributing to market expansion. Furthermore, the increasing number of product approvals, strategic collaborations, and investments by major manufacturers such as Medtronic, Abbott, Boston Scientific, and Edwards Lifesciences continues to strengthen innovation and support the sustained growth of the global cardiac devices market.

Regulatory Landscape and Device Approval Pathways

Cardiac devices undergo rigorous pre-market evaluation before reaching patients. In the United States, the FDA classifies medical devices into three classes (I, II, III), with Class III devices (including ICDs, pacemakers, and VADs) requiring the most stringent Premarket Approval (PMA), a process involving submission of clinical trial data, manufacturing inspections, and post-market surveillance requirements.

In the European Union, the Medical Device Regulation (MDR 2017/745, fully effective May 2021) replaced the older Medical Device Directive (MDD) and significantly strengthened clinical evidence requirements, unique device identification (UDI) systems, post-market clinical follow-up (PMCF), and transparency via the EUDAMED database.

Globally, regulatory harmonisation efforts through the International Medical Device Regulators Forum (IMDRF) are working towards convergent standards for clinical evidence, quality management systems (ISO 13485), and software as a medical device (SaMD) increasingly relevant as AI-driven cardiac device algorithms seek regulatory clearance.

Conclusion

Cardiac devices have irrevocably transformed the management of cardiovascular disease. From the pioneering pacemakers of the 1950s to today’s AI-enhanced, wirelessly connected, miniaturised marvels of medical engineering, these technologies have saved millions of lives, restored functional capacity, and redefined what is possible in the treatment of previously fatal cardiac conditions.

The trajectory of cardiac device innovation points toward an increasingly personalised, predictive, and patient-empowered future. Devices will not only treat disease but also anticipate it, detecting haemodynamic deterioration before symptoms emerge, stratifying arrhythmia risk with molecular precision, and delivering targeted therapy calibrated to each patient’s unique physiology.

Yet technology alone is insufficient. Realising the full promise of cardiac devices requires addressing profound global inequities in access, investing in healthcare infrastructure in LMICs, ensuring robust ethical frameworks for device therapy and data governance, and placing the patient’s values, fears, and aspirations at the centre of every therapeutic decision.

As the burden of cardiovascular disease continues to grow with ageing populations and escalating metabolic risk factors, cardiac devices will remain not only the beating heart of cardiology practice but one of humanity’s most powerful tools in the enduring struggle to preserve and extend life.

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