What question did this study set out to answer?

To explore the feasibility of co-implanting a Micra leadless pacemaker and Cardiac Contractility Modulation device in patients with ATTRwt-CA.

January 10, 2026Journal of Cardiovascular Electrophysiology0 citationsOpen Access

Navigating the Lead Paradox: Successful Co‐Implantation of Cardiac Contractility Modulation Device and a Micra Leadless Pacemaker

GPGabriele PavaniOspedale San Luigi Gonzaga PGPaolo GarroneOspedale San Luigi Gonzaga GVGianpaolo VaraldaOspedale San Luigi Gonzaga

Key Result

Co-implantation of a cardiac contractility modulation device with a Micra leadless pacemaker improved a 78-year-old patient's heart failure status to NYHA Class II at 1 year.

Key Points

To explore the feasibility of co-implanting a Micra leadless pacemaker and Cardiac Contractility Modulation device in patients with ATTRwt-CA.
Detailed a case summary of a 78-year-old male with ATTRwt-CA and NYHA III heart failure.
Utilized a multi-view fluoroscopic technique for spatial separation of devices.
Applied specific device programming to reduce electrical crosstalk after co-implantation.
Patient stabilized to NYHA Class II after one year of treatment.
No further hospitalizations were reported within the year following the procedure.

Structured PICO

Is the co-implantation of a Cardiac Contractility Modulation (CCM) device and a Micra leadless pacemaker feasible and safe in a patient with ATTRwt-CA and refractory heart failure?

Population

1 78-year-old male with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), permanent atrial fibrillation, NYHA class III heart failure, LVEF 30%-35%, and a pre-existing Micra leadless pacemaker.

Intervention

Co-implantation of a Cardiac Contractility Modulation (CCM) device (Optimizer Smart Mini) with two 58 cm active-fixation leads placed on the mid-interventricular septum, utilizing multi-view fluoroscopy and specific device programming to mitigate electrical crosstalk.

Outcome

Feasibility and safety of dual-device co-implantation (absence of electrical crosstalk or pacing inhibition) and clinical stabilization at 1 year.

Co-implantation of a CCM device and a Micra leadless pacemaker is technically feasible and safe, providing a novel therapeutic option for patients with advanced heart failure and pre-existing leadless pacemakers.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

ABSTRACT 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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