Leadless cardiac resynchronization therapy: a distant Utopia

We congratulate Carabelli et al. for their manuscript: ‘European experience with a first totally leadless cardiac resynchronization therapy pacemaker system’,1 describing a multicentred experience of leadless cardiac resynchronization therapy-pacemaker (CRT-P) implant in a niche population. Careful patient selection and procedural execution yielded excellent outcomes: 100% implant success, reduced QRS duration, and improved left ventricular function. The authors have remained appropriately guarded about this combination of technologies and are open about potential drawbacks. CRT-P account for a minority of all CRT devices, as most patients also require the protection of a defibrillator. In principle, a subcutaneous implanted cardioverter-defibrillator (SCICD) could be used in conjunction with the combined...