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

Lukas Bereuter; Thomas Niederhauser; Martin Kucera; Dominic Loosli; Immanuel Steib; Marcel Schildknecht; Adrian Zurbuchen; Fabian Noti; Hildegard Tanner; Tobias Reichlin; Andreas Haeberlin

doi:10.1016/j.hrthm.2019.01.010

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

Heart Rhythm. 2019 Jun;16(6):936-942. doi: 10.1016/j.hrthm.2019.01.010. Epub 2019 Jan 11.

Affiliations

¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland.
² Institute for Human Centered Engineering, Bern University of Applied Sciences, Bern, Switzerland.
³ Swiss Institute for Translational and Entrepreneurial Medicine, University of Bern, Bern, Switzerland.
⁴ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁵ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Hôpital Haut-Lévêque, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France. Electronic address: andreas.haeberlin@insel.ch.

PMID: 30639936
DOI: 10.1016/j.hrthm.2019.01.010

Abstract

Background: 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.

Objective: The purpose of this study was to develop a leadless CRT system and to evaluate its function in vivo.

Methods: 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.

Results: 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.

Conclusion: Leadless PMs are able to synchronize their action using CIC and may overcome the key limitation of contemporary leadless PMs.

Keywords: Intrabody communication; Intracardiac communication; Leadless cardiac resynchronization therapy; Leadless pacemaker; Pacemaker.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Arrhythmias, Cardiac / therapy*
Cardiac Resynchronization Therapy / methods*
Disease Models, Animal
Equipment Design
Pacemaker, Artificial*
Reproducibility of Results
Swine