Feasibility of totally leadless left bundle branch area pacing via a left endocardial pacing electrode in patients with heart failure: A 3-case series

Figures

• 

  Figure 1. Components of the WiSE CRT system: battery, an ultrasound transmitter, and a receiver, and is combined with a pre-existing RV pacing device. CRT = cardiac resynchronization therapy; RV = right ventricle.

• 

  Figure 2. 12-lead ECG showing measurement of V6RWPT = 64 ms and small R-wave in lead V1, suggestive of left bundle branch area pacing (LBBAP). ECG = electrocardiogram; RWPT = R wave peak time.

• 

  Figure 3. 12-lead ECG panel demonstrating QRS morphology at different pacing conditions. ECG = electrocardiogram; RV = right ventricle; LV = left ventricle.

• 

  Figure 4. Left: QRS morphology changes at high (6 V) and low (1.3 V) output. Right: Fluoroscopic view after implantation showing LV electrode (blue star), transmitter (orange star), and Micra VR (white arrow). LAO = left anterior oblique; LV = left ventricle.

• 

  Figure 5. 12-lead ECG and fluoroscopic panel. A: Baseline RV pacing, B: LV only pacing, C: WiSE-CRT system synchronized to RV pacing. CRT, cardiac resynchronization therapy; ECG = electrocardiogram; LV = left ventricle; RV = right ventricle.

• 

  Figure 6. Fluoroscopic and ECG composite panel. A: RV pacing, B: Biventricular pacing using WiSE-CRT synchronized to RV lead, and C: Final fluoroscopic image showing the implanted WiSE-CRT system components. CRT, cardiac resynchronization therapy; ECG = electrocardiogram; RV = right ventricle.