Abstract

Cardiac implantable electronic devices have been successfully treating patients with brady- and tachyarrhythmias for decades. However, there are still significant complications related to this therapy modality, many related to the transvenous lead. Paradigm-shifting technologies, such as the subcutaneous implantable cardioverter–defibrillator (S-ICD) and leadless cardiac pacemakers (LCP), have emerged to address these complications. The novel modular cardiac rhythm management (mCRM) system, consisting of a communicating antitachycardia pacing-enabled LCP and S‑ICD, is the first system to integrate wireless intrabody communication between devices to allow for coordination of leadless pacing and defibrillator therapy delivery. In this review, the design and concept of the mCRM system are presented and available evidence is summarized.

Highlights

  • For many decades, cardiac electrical implantable devices (CIED) have been the cornerstone therapy for patients with brady- and tachyarrhythmias [1,2,3,4]

  • The lowest communication signal amplitude sensed by the leadless cardiac pacemaker (LCP) is when its main axis is perpendicular to the subcutaneous implantable cardioverter defibrillator (S-ICD) communication vector, or when the LCP is approximately parallel with the S-ICD shock coil when the implanted system is viewed in an anterior–posterior view under fluoroscopy

  • The orientation of the LCP relative to the S-ICD communication vector in humans is expected to have a favorable position in relation to the communication vector, with a preferred device deployment in the right ventricular apicoseptal region

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Summary

Introduction

Cardiac electrical implantable devices (CIED) have been the cornerstone therapy for patients with brady- and tachyarrhythmias [1,2,3,4]. MCRM modular cardiac rhythm management, S-ICD subcutaneous implantable cardioverter–defibrillator, LCP leadless cardiac pacemaker, ATP antitachycardia pacing tional conducted communication from S-ICD to LCP, which allows access to ATP therapy but limits additional features that could come from this pairing to future generations of S-ICD pulse generator where bidirectional communication would be possible. To accomplish the objective of adding conducted communication ability to the S-ICD system without updating its hardware, existing circuitry in the S-ICD pulse generator, normally utilized to check shock circuit integrity, was repurposed to send bursts of approximately 25 kHz pulses from the shock coil of the S-ICD electrode to the S-ICD pulse generator can These pulses are low in voltage amplitude (

90 Days p Value
Discussion
Limitations and next steps
Findings
Compliance with ethical guidelines
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