Upgrading expandable leadless pacemakers from single- to dual-chamber

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Device Technology

Background:

• Single-chamber leadless pacemakers (LPs) offer a less invasive alternative to transvenous systems.
• Patients initially implanted with a ventricular LP may later require dual-chamber pacing.
• Evaluating the upgradeability of existing LPs is crucial for long-term patient management.

Purpose of the Study:

• To assess the feasibility and safety of upgrading a ventricular LP to a dual-chamber system by adding an atrial LP.
• To evaluate the performance and electrical stability of the dual-chamber leadless pacing system over 12 months.

Main Methods:

• A prospective, multicentre study involving 35 patients with a prior ventricular LP.
• Attempted implantation of an atrial LP and pairing with the existing ventricular LP for dual-chamber pacing.
• 12-month follow-up assessing device performance, electrical measurements, complications, and battery longevity.

Main Results:

• Successful upgrade to dual-chamber leadless pacing was achieved in 91.4% of patients.
• Atrial device electrical measurements stabilized within one month and remained stable for 12 months.
• Seven procedure-related complications occurred in 14.3% of patients; no deaths were reported. Estimated battery longevity was over 11 years for ventricular and 5.7 years for atrial LPs.

Conclusions:

• Adding an atrial LP to a pre-existing ventricular LP is a feasible and safe strategy for achieving dual-chamber leadless pacing.
• The dual-chamber leadless pacing system demonstrates long-term effectiveness and stability.
• This approach provides a viable upgrade path for patients requiring more advanced pacing support.