Key result
Totally leadless AV-synchronized system achieves LV septal pacing with a QRS duration of ~142 ms.
Why the study?
Atrioventricular-sequential left ventricular pacing triggered by atrial leadless pacing impulse without right ventricular pacing had not been reported.
Does a dual-chamber leadless pacemaker combined with a WiSE left ventricular endocardial electrode provide effective atrioventricular-sequential left ventricular pacing without right ventricular pacing dependency in a patient with complete heart block?
Case Report (n=1)
Does a dual-chamber leadless pacemaker combined with a WiSE left ventricular endocardial electrode provide effective atrioventricular-sequential left ventricular pacing without right ventricular pacing dependency in a patient with complete heart block?
This first-in-human case demonstrates the feasibility of a fully leadless atrioventricular-synchronized system delivering left ventricular septal pacing without relying on right ventricular pacing, avoiding transvenous lead complications.
Supports feasibility of leadless AV-synchronized LV septal pacing; leaves open durability, safety, and outcomes in larger trials.
BACKGROUND: Leadless cardiac resynchronization combining WiSE system ultrasound-mediated left ventricular pacing with leadless right ventricular pacing has been reported. However, atrioventricular-sequential left ventricular pacing triggered by atrial leadless pacing impulse without right ventricular pacing has not been reported. FIRST-IN-HUMAN/EARLY REPORTS SUMMARY: An 86-year-old man with complete heart block and cardiomyopathy received a dual-chamber leadless pacemaker (AVEIR DR) with WiSE left ventricular endocardial electrode on the septal wall. A novel "sync-to-pace" delay configuration enabled the atrial pacing impulse to trigger left ventricular stimulation, achieving a QRS duration of 142 ms. DISCUSSION: This case demonstrates proof of concept for a fully leadless atrioventricular-synchronized system capable of delivering left ventricular septal endocardial pacing without right ventricular pacing dependency, offering a physiological pacing strategy for selected patients. NOVELTY: First-in-human demonstration of an ultrasound-mediated left ventricular endocardial electrode triggered by an atrial leadless pacing impulse to deliver atrioventricular-sequential left ventricular septal stimulation without right ventricular pacing. TAKE-HOME MESSAGE: This novel totally leadless architecture is a proof of concept for a more physiological pacing option for pacing-dependent patients while avoiding transvenous lead-related complications.
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Dababneh et al. (2026) conducted a case report in Complete heart block and cardiomyopathy (n=1). Dual-chamber leadless pacemaker (AVEIR DR) with WiSE left ventricular endocardial electrode was evaluated on QRS duration. A totally leadless atrioventricular-synchronized system delivered left ventricular septal endocardial pacing without right ventricular pacing dependency, achieving a QRS duration of 142 ms.
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