9-02: First Report On Communicating Leadless Anti-Tachycardia Pacemaker And Subcutaneous Implantable Defibrillator - The Next Step In Cardiac Rhythm Management

Introduction: With the aim of eliminating lead and pocket related complications, we examine the next step in multi-component leadless cardiac rhythm management (CRM): feasibility of an anti-tachycardia (ATP) leadless cardiac pacemaker (LCP), commanded by an implanted S-ICD through wireless, intra-body, device-device communication.

Methods: The first experiments were conducted in sheep (n = 2) with implantation of ATP-enabled LCP and S-ICD prototypes (Boston Scientific). LCP performance, LCP-programmer and LCP-S-ICD communication (both through conductive communication) were tested. ATP-commands, initiated via the S-ICD programmer, were transmitted by the S-ICD to the LCP and LCP response was evaluated.

Results: The LCP and S-ICD were successfully implanted (Panel A). LCP performance was adequate and demonstrated appropriate VVI behavior. Programmer and LCP-S-ICD communication were established without interference. Uni-directional communication between the S-ICD and LCP was successful in all (n = 15) attempts (Panel B) resulting in ATP delivery by the LCP (10 beats at 81% of coupling interval). Acute LCP retrieval was successful. Data on additional experiments with automatic S-ICD initiated ATP-delivery in porcine (n = 4), canine (n = 8), and ovine (n = 6) animal models will be added to this analysis.

Conclusion: We present the first proof of concept study with the combined implant of an ATP-enabled LCP and S-ICD. We demonstrated appropriate VVI functionality, successful wireless device-device communication and ATP-delivery by the LCP. Data from 18 animal experiments will be added to this analysis and presented. Further studies on safety and performance are needed.

Open in new tabDownload slide