The utility of a combined synchronous atrioventricular leadless pacemaker and subcutaneous implantable cardiac defibrillator system in bilateral upper limb venous occlusion

His-Optimized Cardiac Resynchronization Therapy (HOT-CRT) in a subcutaneous ICD patient: first-in-human case report

“…Many cases of the concomitant use of s-ICD and TV-PPM 9,10 , epicardial PPM 11 , epicardial CRT-P 12 , and HBP devices 13 have been reported. In addition, there are numerous case-reports of the associated use of leadless PPM (LP) and s-ICD 14 . Indeed, Boston Scientific has developed a hybrid LP (EMPOWER) plus s-ICD (EMBLEM) system that is able to provide anti-bradycardia pacing and anti-tachycardia pacing together with shocks 15 , and which is currently under investigation (Modular ATP trial, NCT04798768).…”

Leadless Cardiac Pacing: New Horizons

“…A similar concept has been successfully tested by a new device, the EMPOWER/EMBLEM unit (Boston Scientific, Marlborough, MA, USA), which uses their S-ICD in addition to an LP implanted in the right ventricle which can deliver both VVI pacing and ATP and demonstrated excellent performance up to 18 months in a preclinical model [46,47]. Furthermore, a case report of a Micra AV pacemaker implanted along with an S-ICD showed the feasibility of AV synchronous pacing alongside an extravascular ICD [48]; however, the lack of cross-communication between the two devices (made by different companies) highlights the complexity and the need for further clinical research. An alternative extravascular ICD (Medtronic) is currently being tested in a clinical study, the EV ICD study (NCT04060680); this device comprises a substernal, extravascular lead which, in addition to defibrillation, can enable epicardial ATP and pacing owing to the proximity to the heart [49].…”