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Leadless dual-chamber pacing – a novel communication method for wireless pacemaker synchronization
Objectives The goal of this study was to provide a proof-of-concept for leadless dual-chamber pacing. Background Recently introduced leadless cardiac pacemakers effectively overcome the lead- and pocket-related limitations of conventional pacemakers. However, they only feature single-chamber pacing capability although dual-chamber pacing and synchronization between different pacing sites is highly desirable for most patients. Methods The presented concept involves two separate leadless pacemakers that jointly act as a leadless dual-chamber pacemaker. To preserve synchrony, these devices must communicate wirelessly with each other. Low power conductive intra-body communication was implemented as communication method, which uses blood and myocardial tissue as signal transmission medium. First, the intra-body communication characteristics of the heart were measured ex vivo and in vivo on porcine hearts. These findings were subsequently used to develop a leadless dual-chamber pacemaker prototype, which was tested in vivo. Results The pacemaker successfully performed dual-chamber pacing (D00) with wireless intra-body communication. No interference with the cardiac function was observed. The characterization measurements propose optimal communication frequencies at approximately 100 kHz or higher. The average transmission power for pacemaker synchronization can be as low as 0.1 % of the power consumption of contemporary leadless pacemakers. Conclusions Highly energy-efficient intra-body communication has shown to be feasible allowing leadless dual-chamber pacing. Intra-body communication may in future also enable leadless cardiac resynchronization therapy.
