Fundamental Characterization of Conductive Intracardiac Communication for Leadless Multisite Pacemaker Systems

• Published in: IEEE transactions on biomedical circuits and systems Vol. 13; no. 1; pp. 237 - 247
• Main Authors: Bereuter, Lukas, Kuenzle, Timon, Niederhauser, Thomas, Kucera, Martin, Obrist, Dominik, Reichlin, Tobias, Tanner, Hildegard, Haeberlin, Andreas
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.02.2019; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Attenuation; Biological system modeling; Channel characterization; Communication; conductive intracardiac communication; Conductivity; Electrodes; Energy efficiency; Energy management; Finite element analysis; finite-element; Frequency ranges; Heart; Impedance; intra-body communication; Lead; leadless CRT; leadless dual-chamber pacing; leadless pacemaker; Mathematical model; Mathematical models; multisite pacing; Pacemakers; Parameter identification; Power consumption; Power management; Signal transmission; Surgical implants; Synchronism; Synchronization; System effectiveness; wireless; Wireless communications
• ISSN: 1932-4545; 1940-9990
• DOI: 10.1109/TBCAS.2018.2886042

Objective: A new generation of leadless cardiac pacemakers effectively overcomes the main limitations of conventional devices, but only offer single-chamber pacing, although dual-chamber or multisite pacing is highly desirable for most patients. The combination of several leadless pacemakers could facilitate a leadless multisite pacemaker but requires an energy-efficient wireless communication for device synchronization. This study investigates the characteristics of conductive intracardiac communication between leadless pacemakers to provide a basis for future designs of leadless multisite pacemaker systems. Methods: Signal propagation and impedance behavior of blood and heart tissue were examined by in vitro and in vivo measurements on domestic pig hearts and by finite-element simulations in the frequency range of 1 kHz to 1 MHz. Results: A better signal transmission was obtained for frequencies higher than 10 kHz. The influence of a variety of practical parameters on signal transmission could be identified. A larger distance between pacemakers increases signal attenuation. A better signal transmission is obtained through larger inter-electrode distances and a larger electrode surface area. Furthermore, the influence of pacemaker encapsulation and relative device orientation was assessed. Conclusion: This study suggests that conductive intracardiac communication is well suited to be incorporated in leadless pacemakers. It potentially offers very low power consumption using low communication frequencies. Significance: The presented technique enables highly desired leadless multisite pacing in near future.