Leadless cardiac resynchronization therapy: An in vivo proof-of-concept study of wireless pacemaker synchronization

• Published in: Heart rhythm Vol. 16; no. 6; pp. 936 - 942
• Main Authors: Bereuter, Lukas, Niederhauser, Thomas, Kucera, Martin, Loosli, Dominic, Steib, Immanuel, Schildknecht, Marcel, Zurbuchen, Adrian, Noti, Fabian, Tanner, Hildegard, Reichlin, Tobias, Haeberlin, Andreas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019
• Subjects: Intrabody communication; Intracardiac communication; Leadless cardiac resynchronization therapy; Leadless pacemaker; Pacemaker; Intrabody communication; Leadless cardiac resynchronization therapy; Pacemaker; Leadless pacemaker; Intracardiac communication
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2019.01.010

Contemporary leadless pacemakers (PMs) only feature single-chamber ventricular pacing. However, the majority of patients require dual-chamber pacing or cardiac resynchronization therapy (CRT). Several leadless PMs implanted in the same heart would make that possible if they were able to synchronize their activity in an efficient, safe, and reliable way. Thus, a dedicated ultra-low-power wireless communication method for PM synchronization is required. The purpose of this study was to develop a leadless CRT system and to evaluate its function in vivo. Device synchronization was implemented using conductive intracardiac communication (CIC). Communication frequencies were optimized for intracardiac device–device communication. Energy consumption, safety, and reliability of the leadless PM system were tested in animal experiments. We successfully performed CRT pacing with 3 independent devices synchronizing their action using CIC. No arrhythmias were induced by the novel communication technique. Ninety-eight percent of all communication impulses were transmitted successfully. The optimal communication frequency was around 1 MHz, with a corresponding transmitted power of only 0.3 μW at a heart rate of 60 bpm. Leadless PMs are able to synchronize their action using CIC and may overcome the key limitation of contemporary leadless PMs.