The Leadless Frontier in Cardiac Resynchronization: Leadless Right Ventricular Combined with Endocardial Left Ventricular Pacing

Figures

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  Figure 1. Anteroposterior view showing the final position of the WiSE-CRT electrode in the midbasal interventricular septum. The blue arrows indicate the endocardial electrode, the WiSE transmitter, and the leadless AVEIR pacemaker. WiSE-CRT = wireless stimulation endocardially for cardiac resynchronization therapy.

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  Figure 2. A: Right ventricular pacing with a leadless AVEIR pacemaker. The QRS duration is 184 ms. B: Biventricular pacing with a WiSE device is shown. The QRS fragmentation in the inferior leads reflects left septal activation that precedes the activation of the lateral wall but is not fully synchronized with right ventricular pacing, resulting in a complex and nonuniform activation pattern. The isodiphasic QRS in V1 and the QS morphology from V2 to V6 show that depolarization still propagates predominantly from right to left, although with improved electrical synchrony compared with isolated right ventricular pacing, as evidenced by the shorter QRS duration (140 ms). WiSE = wireless stimulation endocardially.