Electronic pacemakers have succeeded in saving the lives of millions by providing medical palliation for cardiac conduction abnormalities. However, the caveats associated with usage of the same have prompted research in the development of a biological alternative which could replace or supplement its electronic counterpart. Biopacemaking could be done either by genetic engineering, cellular therapy or a combination of both. Ion channels and calcium handling proteins which form the key molecular players of the cardiac pacemaker action potential were the primary candidates for gene therapy based biopacemaking. Modulation of ion channels and other pacemaking associated proteins, either by gene delivery/ cell therapy or a combination of both have been researched in great detail. Pluripotent/ multipotent stem cells serve as excellent vehicles for carrying such genes which have been tailored to ensure that the implanted cell transforms into a pacemaker-like cell. Implantation of hybrid/ tandem pacemakers could overcome the risk associated with the malfunction of either the biological or electronic pacemaker in the patient. This review article highlights the recent developments in this area of biopacemaking, classifies it based on the principle of possible execution and discusses to fair length patents that could project the biological pacemaker into the clinical scenario very soon.
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