Leadless LV electrodes
EBR systems
WiSE CRT trials 2014
SELECT LV trial 2017
1st implant in Australia at Monash 2018
Delivers ultrasonic energy from a transmitted (lateral implant) to LV endocardial receiver (size of grain of rice)
Patient must already have a transvenous RV lead.
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LV electrode sensor timed to sensed RV pacing stimulus
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Part 1: Battery & transmitter
Pocket is created in the left lateral chest wall position via an oblique incision across the mid-axillary line at the level of the 5th rib.
Vertical incision is made across the 4th intercostal space 8cm lateral to the left sternal edge.
Dissection to level of external intercostal muscle. Periosteum of 4th and 5th ribs exposed.
Wise CRT transmitter sutured to the periosteum of the 4th & 5th ribs
Transmitter pocket dilated.
Transmitter lead tunnelled deep to the external intercostal muscle to the pocket in the mid-axillary line.
Connected to EBR systems WISE CRT pulse generator & positioned partially behind latissimus dorsi and sutured to the superficial fascia of serratus anterior
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Part 2: Electrode
Access into LV either using a special catheter by
•RFV via LA (transeptal puncture) or
•RFA via Ao
Electrode tested
Electrode released