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Navigating the Lead Paradox: Successful Co-Implantation of Cardiac Contractility Modulation Device and a Micra
Gabriele Pavani1,2,3,4, Paolo Garrone1,3, Gianpaolo Varalda1,3
1Cardiac Electrophysiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
Background:
Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) can lead to refractory heart failure. A "lead paradox" occurs when patients with a Micra leadless pacemaker require lead-based Cardiac Contractility Modulation (CCM) therapy.
Case Summary:
We detail the first co-implantation of CCM and Micra devices in a 78-year-old male with ATTRwt-CA and NYHA III heart failure. A multi-view fluoroscopic technique ensured spatial separation, while specific device programming mitigated electrical crosstalk post-procedure.
Conclusion:
At 1 year, the patient stabilized to NYHA Class II without further hospitalizations. This dual-device strategy is a feasible and safe technical roadmap for this complex clinical problem.
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