PO-687-07 NOVEL PACING TECHNIQUE FOR A PATIENT WITH COMPLETE HEART BLOCK AND NO VENOUS ACCESS, UTILIZING THE WISE-CRT SYSTEM

Abstract

n/a Wise-CRT for unconditional pacing n/a 30-year-old man with medical history significant for hypertension, system lupus, coronary artery disease s/p CABG in 2019, chronic kidney disease on hemodialysis, with multiple dialysis catheter placement in the past, currently has a transhepatic catheter, which has gotten infected multiple times, who presented after a syncope episode, and found to be in complete heart block with junctional escape rhythm at 35 bpms. Attempts to implant a leadless pacemaker was unsuccessful because both his common iliacs (right and left) were completely closed likely because of multiple dialysis catheter placement, decision was made to go to the right internal jugular however again his SVC was chronically closed. At this point the patient had two options, wither to have a transhepatic approach and place a ventricular lead through that access however, given his infection history with MRSA, VRE, and multiple transhepatic catheter infection it would be inevitable for him to develop endocarditis, or to have an epicardially placed leads. He was taken to the OR and THREE epicardial leads were placed, one of which was capturing in the OR with acceptable thresholds ∼ 2 mV however next day, non or the three epicardial leads are capturing and the patient remains in complete heart block with junctional escape rhythm at 35 beats per minutes. FDA compassionate one time use and IRB approval were obtained. In this case, the novel pacing techniques was implanting Wise-CRT system via a retrograde aortic access, and placed in the lateral wall of the left ventricular endocardially under TEE and Fluoroscopy Guidance (Picture). The device transmitter programmed to sense the pacing pulse (spikes) from currently placed non-capturing epicardial lead and send ultrasound energy signals to the endocardiac receiver electrode which in turn paced the ventricular. Procedure was done successfully without any complications. Wise-CRT can be used as a single pacing system in patient with no Venous Access