Dual chamber leadless pacing with implant-to-implant communication!

Ninety eight percent atrioventricular synchrony has been demonstrated by implant-to-implant communication with two leadless pacemakers, one in the atrium and another in the ventricle [1]. AV synchrony was maintained across postures and activities even with heart rate above 100 beats per minute. That was in a prospective, single arm, unblinded, multicenter, international clinical trial of the leadless pacemaker system. Of the 463 patients enrolled, 384 were evaluable. 12-lead Holter ECG recordings were collected 3 months after implantation over various postures/activities like sitting, supine, left lateral recumbent, standing, normal walk, and fast walk.

The leadless dual chamber pacemaker system was designed for AV synchronous pacing using wireless, beat-to-beat, implant-to-implant (i2i) communication between distinct atrial and ventricular leadless pacemakers. Though AV synchrony can be definitively verified only by manual ECG evaluation, i2i success rates can be readily obtained by interrogation of the devices using a programmer. It can be used as surrogate for AV synchrony estimation. Freedom from device or procedure related complications, atrial capture and sensing threshold and AV synchrony in sitting posture were the safety parameters evaluated. Reasons for exclusion of eighty odd patients from the analysis were withdrawn consent, leadless pacemaker fixation, improper device programming and ECG signals with persistent noise or low amplitude signals. These reasons were independent of i2i communication, which was the focus of evaluation.

Reference

1. Ip JE, Rashtian M, Exner DV, Reddy VY, Doshi R, Badie N, Nevo JR, Goil A, Defaye P, Canby R, Bongiorni MG, Shoda M, Hindricks G, Knops RE. Atrioventricular Synchrony Delivered by a Dual-Chamber Leadless Pacemaker System. Circulation. 2024 Aug 6;150(6):439-450. doi: 10.1161/CIRCULATIONAHA.124.069006. Epub 2024 Jul 8. PMID: 38973458; PMCID: PMC11305627.