Artificial Intelligence and the Future of Cardiac Implantable Electronic Devices: Diagnostics, Monitoring, and Therapy

Cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronisation therapy (CRT) devices are generating unprecedented volumes of data in both inpatient and remote settings. Artificial intelligence (AI) techniques are increasingly being applied to enhance the management of these devices and the patients who rely on them. Recent advances demonstrate that machine learning (ML) and deep learning (DL) can improve diagnostic capabilities (for example, by detecting arrhythmias and predicting clinical events), streamline remote monitoring workflows, and optimise device-based therapies. Key applications include AI-driven algorithms that accurately detect true arrhythmias while filtering out false alerts from pacemakers and implantable monitors, neural network models that predict ventricular arrhythmias weeks before ICD shocks, and personalised models that forecast which heart failure patients will respond to CRT. Moreover, novel approaches such as natural language processing (NLP) and reinforcement learning are being explored to integrate diverse data sources and to enable devices to self-adjust their programming. This narrative review summarises the major applications of AI in the CIED domain-diagnostics, remote monitoring, and therapy optimisation-with an emphasis on the recent literature over the past five years. The review highlights important studies and randomised trials in each area, discusses the variety of AI techniques employed, and outlines future directions and challenges (including data standardisation, validation in clinical trials, and regulatory considerations) for translating these innovations into routine clinical care.