Leadless Dual-Chamber Pacing

Bereuter, Lukas; Gysin, Mirco; Kueffer, Thomas; Kučera, Martin; Niederhäuser, Thomas; Fuhrer, Jürg; Heinisch, Paul Philipp; Zurbuchen, Adrian; Obrist, Dominik; Tanner, Hildegard; Haeberlin, Andreas

doi:10.1016/j.jacbts.2018.07.009

Cited by 42 publications

(26 citation statements)

References 19 publications

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“…43 LCP implantation was successful in 98% of recipients, and the only procedure-related complication was groin hematoma. 44 Indeed, leadless devices are still in development, and there are also the prototypes of dualchamber systems, 45 which may be used in a wider group of patients. As such, LCPs are a potential game changer for modern CIEDs.…”

Section: Leadless Cardiac Pacemakersmentioning

confidence: 99%

<p>Cardiac Electronic Devices: Future Directions and Challenges</p>

Kotalczyk¹,

Kalarus²,

Wright³

et al. 2020

MDER

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Cardiovascular implantable electronic devices (CIEDs) are essential management options for patients with brady-and tachyarrhythmias or heart failure with concomitant optimal pharmacotherapy. Despite increasing technological advances, there are still gaps in the management of CIED patients, eg, the growing number of lead-and pocket-related longterm complications, including cardiac device-related infective endocarditis, requires the greatest care. Likewise, patients with CIEDs should be monitored remotely as a part of a comprehensive, holistic management approach. In addition, novel technologies used in smartwatches may be a convenient tool for long-term atrial fibrillation (AF) screening, especially in high-risk populations. Early detection of AF may reduce the risk of stroke and other AF-related complications. The objective of this review article was to provide an overview of novel technologies in cardiac rhythm-management devices and future challenges related to CIEDs.

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Section: Leadless Cardiac Pacemakersmentioning

confidence: 99%

<p>Cardiac Electronic Devices: Future Directions and Challenges</p>

Kotalczyk¹,

Kalarus²,

Wright³

et al. 2020

MDER

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“…In a nutshell, conventional DDD pacing mode possesses pacing and sensing capabilities in both the atrium and the ventricle, which is regulated by the pacemaker pulse generator unit. However, in wireless DDD mode, the regulation is supported by explicit pulse communication mechanism between the units [9], [10]. The proposed leadless pacemaker system has units implanted in the atrium and ventricle, as shown in Fig.…”

Section: A Dual Chamber Pacemaker System (Wireless-ddd Mode)mentioning

confidence: 99%

“…In the case of patients with bradyarrhythmia's, atrium and the ventricular chambers experience change in rhythm and are missing to contract at coordinated time instants. The dual-chamber leadless pacemaker systems are being utilized to regulate the rhythm, and it is available in different pacing configurations [4], [9], [13]. The pacing configuration has several pacing modes, but DDD mode is considered to mimic the heart best than other modes [21].…”

Section: Introductionmentioning

confidence: 99%

“…If units operate independently, the uncoordinated pacing action by units at the atrium and ventricle will lead to change in the rhythm of heart, leading to device induced bradyarrhythmia conditions. Therefore, there is a need for synchronization between the units in order to achieve coordination between the atrium and ventricular contraction [9], [22]. However, synchronization mechanism consumes energy, and this affects the longevity of the units.…”

Section: Introductionmentioning

confidence: 99%

“…A radio frequency (RF) pulse-based technique can be used to establish the synchronization between the units where the RF pulse is transmitted from atrial unit to ventricular unit on every heartbeat [9], [10]. The received RF pulse at ventricle unit provides the time reference to predict the time of ventricular contraction, this information is used to provide coordination between the chambers.…”

Section: Introductionmentioning

confidence: 99%

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Patient Specific Strategies to Enhance Leadless Pacemaker Lifetime in Synchronized Dual Chamber System

et al. 2020

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Dual chamber leadless pacemakers are multi-unit, battery-driven implants utilized for treating patients with bradyarrhythmias and sino-atrial dysfunctions. Establishing synchronization between the units provides coordination between the atrium and ventricular contraction, and this mechanism depletes battery energy. Due to implant size constraints, reducing the synchronization energy consumed to enhance the lifetime of the implant is crucial. In this paper, a set of strategies are proposed and evaluated to indicate the best strategy to enhance the lifetime of atrial unit based on the patient's heart condition. Beat selective pulse transmission is employed instead of pulse transmission on every beat to reduce energy consumption. The characteristics of interbeat contraction timing of the atrium and ventricle from the patient data is modeled as time series. The designed model is extended to model synchronization strategies with sufficient synchronization accuracy and reduction in energy consumption. It is found that the implant lifetime is dependent on the natural atrial contraction probability, which is patient specific. A relation between the transmission duty-cycle and natural atrial contraction probability is derived for all the strategies, and this analysis is used in a case study to quantify the longevity. The proposed strategies show improved lifetime in comparison to the reference strategy. In the case study, for natural atrial contraction probability of 0.1, longevity is increased by two orders in relation to the reference strategy with the longevity of 4 years. However, there is no one best strategy; instead, the most energy-efficient strategy is determined from patient's natural atrial contraction probability and tolerance to suboptimal coordination. INDEX TERMS Leadless pacemaker synchronization, improved atrial longevity, atrium and ventricle interbeat timing model, energy-efficient synchronization, interbeat time series equation.

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Clinical outcome for heart failure hospitalizations in patients with leadless pacemaker

Katsuki

Nagashima

Kono

et al. 2022

Journal of Arrhythmia

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Introduction The long‐term performance of leadless pacemaker (LPM) has not been well evaluated. Methods Between September 2017 and January 2021, 929 consecutive patients who underwent pacemaker implantation were grouped according to the types of pacemakers: LPM (LPM group, n = 368) and conventional pacemaker (PM group, n = 561). Results The median follow‐up duration was 1.7 years (interquartile range 0.8–2.6 years). Hospitalization rate for heart failure in the LPM group was 9.3%, 15.6%, and 21.6% at 1, 2, 3 years, respectively. The LPM group had a significantly higher adjusted heart failure hospitalization risk than the PM group [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.09–2.64, p = .01]. More patients with symptomatic bradycardia caused by sinus node dysfunction (SND) in the LPM group (n = 150) were admitted to the hospital for heart failure compared to those in the PM group (n = 219) (HR 2.02, 95%CI 1.04–3.90, p = .03), whereas no significant difference was observed between the two groups in the patients with bradycardia caused by atrial fibrillation (LPM group, n = 71; PM group, n = 18) or atrioventricular block (LPM group, n = 147; PM group, n = 324). Conclusions Patients who received LPM implantation had greater hospitalization risk for heart failure, compared to those who received conventional pacemaker implantation. The increased risk was mainly attributed to patients with SND.

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Leadless Dual-Chamber Pacing

Abstract: Visual Abstract

Cited by 42 publications

References 19 publications

<p>Cardiac Electronic Devices: Future Directions and Challenges</p>

<p>Cardiac Electronic Devices: Future Directions and Challenges</p>

Patient Specific Strategies to Enhance Leadless Pacemaker Lifetime in Synchronized Dual Chamber System

Clinical outcome for heart failure hospitalizations in patients with leadless pacemaker

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