Abstract
The importance of leadless pacemaker positioning in relation to subcutaneous implantable cardioverter-defibrillator sensing in completely leadless cardiac resynchronization and defibrillation systems
Highlights
Leadless pacemakers and subcutaneous implantable cardioverter-defibrillators (S-ICDs) are attractive options to reduce the risks associated with transvenous systems, such as vascular access complications and recurrent lead infections, and their clinical use is increasing.[1,2] Leadless cardiac resynchronization therapy (CRT) can be delivered using the WiSE-CRT system (EBR Systems, Sunnyvale, CA), which improves symptoms and left ventricular (LV) remodeling in patients who are untreatable or nonresponders to conventional CRT.[3,4] This system uses ultrasound-based wireless communication between a submuscular transmitter and an endocardial electrode to deliver LV pacing, and requires an existing device capable of delivering continuous right ventricular (RV) pacing to achieve CRT
We report the case of a patient with a completely leadless CRT defibrillator system where implant of a new Micra leadless pacemaker resulted in an inappropriate shock from the subcutaneous implantable cardioverterdefibrillator (S-ICD)
Elliott et al Leadless Pacemaker Position and S-ICD Sensing in Leadless CRT-D Systems chronic kidney disease, persistent atrial fibrillation, and underlying complete heart block underwent implantation of a completely leadless primary prevention CRT defibrillator system after multiple previous device extractions for recurrent infections, as previously reported.[6]
Summary
Leadless pacemakers and subcutaneous implantable cardioverter-defibrillators (S-ICDs) are attractive options to reduce the risks associated with transvenous systems, such as vascular access complications and recurrent lead infections, and their clinical use is increasing.[1,2] Leadless cardiac resynchronization therapy (CRT) can be delivered using the WiSE-CRT system (EBR Systems, Sunnyvale, CA), which improves symptoms and left ventricular (LV) remodeling in patients who are untreatable or nonresponders to conventional CRT.[3,4] This system uses ultrasound-based wireless communication between a submuscular transmitter and an endocardial electrode to deliver LV pacing, and requires an existing device capable of delivering continuous right ventricular (RV) pacing to achieve CRT. A combination of the Micra leadless pacemaker (Medtronic, Fridely, MN) and the WISE-CRT system has demonstrated the feasibility to deliver leadless CRT5 and the addition of an S-ICD (Emblem S-ICD; Boston Scientific, Marlborough, MS) has demonstrated the ability to have a completely leadless CRT defibrillator system.[6] These devices are not designed to be used together, and co-implantation requires complex
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