Author + information
- Received February 7, 2020
- Revision received February 18, 2020
- Accepted February 20, 2020
- Published online May 18, 2020.
- Baldeep S. Sidhu, BMa,b,∗ (, )
- Justin Gould, MBBS, PhDa,b,
- Bradley Porter, MBChB, PhDa,b,
- Mark Elliott, MBBSa,b,
- Vishal Mehta, MBBSa,b,
- Steven Niederer, DPhila and
- Christopher A. Rinaldi, MDa,b
- aSchool of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- bGuy’s and St. Thomas’ Hospital, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Baldeep Singh Sidhu, School of Biomedical Engineering and Imaging Sciences, 4th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom.
A 63-year-old patient with ischemic cardiomyopathy, severe left ventricular systolic dysfunction, atrial fibrillation with underlying complete heart block, and a conventional cardiac resynchronization therapy-defibrillator (CRT-D), was diagnosed with a device-related infection. This device was extracted in its entirety and reimplanted on the contralateral side. Unfortunately, a few months later the new system became infected and, given the patient’s recurring infections, it was decided to attempt a leadless pacing system consisting of a Micra transcatheter pacing system (Medtronic, Fridely, Minnesota), a WiSE-cardiac resynchronization therapy (WiSE-CRT) (EBR Systems, Sunnyvale, California), and an Emblem subcutaneous implantable cardioverter-defibrillator (S-ICD) (Boston Scientific, Marlborough, Massachusetts). The infected system was removed, and the Micra was implanted in the right ventricular septum. The patient subsequently underwent leadless left ventricular endocardial stimulation with a WiSE-CRT system (1). The electrode was implanted in the basal-lateral wall of the left ventricle, the ultrasound transmitter in the fifth intercostal space, and the generator in the mid-axillary line. The patient was discharged home and on follow-up 1 month later, had symptomatic improvement and reliable biventricular pacing. He was readmitted for S-ICD implantation, with the battery implanted posteriorly and the system entirely separate from the WiSE-CRT system (Figure 1). Following implantation, he underwent successful defibrillation threshold testing, and biventricular pacing was confirmed prior to discharge home.
To the authors’ knowledge, this is the first case to report the successful implantation of an entirely leadless CRT-D. Although these pacing systems have been used previously (1–3), they have not been used in a single patient, and this raised a number of technical issues. First, it was important that both the WiSE-CRT system and the S-ICD were kept separate and batteries occupied their own respective pockets to ensure no interference with pacing nor detection of arrhythmia. Second, the S-ICD battery needed to be situated posteriorly and the WiSE-CRT system more anteriorly than normal to ensure the latter system was not involved in the shocking vector. This case demonstrates the possibilities of leadless pacing and, with evolving technology, will become more common.
The authors thank Michael Lee for contribution to the successful implantation of this leadless pacing system.
Dr. Sidhu has received support from the National Institute for Health Research. Dr. Gould has received funding from Rosetrees Trust. Drs. Gould, Porter, Elliott, and Mehta have received funding from Abbott. Dr. Rinaldi has received research funding from and is a consultant for EBR Systems, Abbott, Medtronic, and Boston Scientific. EBR Systems supported this work but did not take part in the data collection, analysis, manuscript writing, or in the decision to submit the paper for publication. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 7, 2020.
- Revision received February 18, 2020.
- Accepted February 20, 2020.
- 2020 The Authors
- Galand V.,
- Pollin B.,
- Martins R.P.,
- Leclercq C.
- Bhatia N.,
- El-Chami M.
- Sidhu B.S.,
- Lee A.W.C.,
- Haberland U.,
- Rajani R.,
- Niederer S.,
- Rinaldi C.A.