Wireless Communication Between Paired Leadless Pacemakers for Dual-Chamber Synchrony

• Published in: Circulation. Arrhythmia and electrophysiology Vol. 15; no. 7; p. e010909
• Main Authors: Cantillon, Daniel J., Gambhir, Alok, Banker, Rajesh, Rashtian, Mayer, Doshi, Rahul, Badie, Nima, Booth, Daniel, Yang, Weiqun, Nee, Peter, Fishler, Matthew, Ligon, David, Neuzil, Petr, Knops, Reinoud E.
• Format: Journal Article
• Language: English
• Published: Ovid Technologies (Wolters Kluwer Health) 01.07.2022; Lippincott Williams & Wilkins
• Subjects: Animals; Cardiac Pacing, Artificial; Communication; Equipment Design; Heart Atria; Heart Ventricles; Humans; Lipopolysaccharides; Pacemaker, Artificial; Sheep
• ISSN: 1941-3149; 1941-3084; 1941-3084
• DOI: 10.1161/circep.122.010909

Leadless pacemakers (LPs) can mitigate conventional pacemaker complications related to the transvenous leads and subcutaneous pocket surrounding the pulse generator. Although single-chamber leadless pacing has been established, multichamber pacing requires wireless bidirectional communication across multiple LPs to maintain synchrony. This preclinical study demonstrates the chronic performance of implant-to-implant (i2i) communication that achieves synchronous, dual-chamber pacing with 2 LPs.BACKGROUNDLeadless pacemakers (LPs) can mitigate conventional pacemaker complications related to the transvenous leads and subcutaneous pocket surrounding the pulse generator. Although single-chamber leadless pacing has been established, multichamber pacing requires wireless bidirectional communication across multiple LPs to maintain synchrony. This preclinical study demonstrates the chronic performance of implant-to-implant (i2i) communication that achieves synchronous, dual-chamber pacing with 2 LPs.The i2i communication modality employs subthreshold electrical signals conducted between implanted LPs through the blood and myocardial tissue on a beat-by-beat basis. Right atrial and right ventricular LPs were implanted in 9 ovine subjects. The i2i transmission performance was evaluated 13 weeks after implant.METHODSThe i2i communication modality employs subthreshold electrical signals conducted between implanted LPs through the blood and myocardial tissue on a beat-by-beat basis. Right atrial and right ventricular LPs were implanted in 9 ovine subjects. The i2i transmission performance was evaluated 13 weeks after implant.Right atrial and right ventricular LPs were implanted successfully and without complication in 9 ovine subjects. A total of 8715±457 right atrial-to-right ventricular and right ventricular-to-right atrial transmissions were sent per hour, with a success rate of 99.2±0.9%. Of periods with i2i communication failure when DDD pacing was not possible, 97.3±1.8% were resolved within 6 s.RESULTSRight atrial and right ventricular LPs were implanted successfully and without complication in 9 ovine subjects. A total of 8715±457 right atrial-to-right ventricular and right ventricular-to-right atrial transmissions were sent per hour, with a success rate of 99.2±0.9%. Of periods with i2i communication failure when DDD pacing was not possible, 97.3±1.8% were resolved within 6 s.For the first time, synchronized, dual-chamber pacing has been demonstrated in a chronic preclinical feasibility study by 2 leadless pacemakers using beat-to-beat, wireless communication, achieving a success rate of 99.2%.CONCLUSIONSFor the first time, synchronized, dual-chamber pacing has been demonstrated in a chronic preclinical feasibility study by 2 leadless pacemakers using beat-to-beat, wireless communication, achieving a success rate of 99.2%.