Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices

Abstract

Cardiac disease is a leading cause of death worldwide. Disturbance in the conduction system of the heart may trigger or aggravate heart dysfunction, affecting the efficiency of the heart, and lead to heart failure or cardiac arrest. Patients may require implantable cardiac rhythm management devices (ICRMDs) to maintain or restore the heart rhythm. ICRMDs have undergone important improvements, yet limitations still exist, presenting important technological challenges. Most ICRMDs consist of a subcutaneous control unit and intracardiac electrodes. The leads, which connect the electrodes to the control unit, are usually placed transvenously through the subclavian veins. Various locations inside the heart are used for placement of electrodes, depending on the specific condition. Some of the limitations to effective pacemaker therapy are associated with placement and location of the leads. Various approaches have been developed to overcome these challenges, such as multi-site pacing and leadless solutions. This paper aims to review the state of the art for the selection of placement sites for pacemakers, implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy devices (CRT) devices and discuss potential technological advancements to improve the results of ICRMD-therapy including development av leadless technology.

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Figure 1

[The heart figure has been modified and reprinted with permission of Pearson Education, Inc., New York, New York116]. [The images of the devices shown in all figures (Platinium™) are trademark of LivaNova, London, UK].

Figure 2

[The heart figure has been modified and reprinted with permission of Pearson Education, Inc., New York, New York116].

Figure 3

[The heart figure has been modified and reprinted with permission of Pearson Education, Inc., New York, New York116].

Figure 4

[The heart figure has been modified and reprinted with permission of Pearson Education, Inc., New York, New York116].

Figure 5
Figure 6

[The heart figure has been modified and reprinted by permission of Pearson Education, Inc., New York, New York116].

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Acknowledgments

This work was funded by the European Union’s H2020: MSCA: ITN program for the “Wireless In-body Environment Communication—WiBEC” project under the Grant Agreement No. 675353.

Conflict of interest

Dr. Hans Henrik Odland reports personal fees from Abbot, grants from Medtronic, outside the submitted work. The other authors have nothing to disclose.

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Albatat, M., Bergsland, J., Arevalo, H. et al. Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 48, 26–46 (2020). https://doi.org/10.1007/s10439-019-02376-0

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Keywords

  • Pacemaker
  • ICD
  • CRT
  • Electrophysiology