A new era for cardiac rhythm management devices: Solutions for transvenous lead complications

Both pacemakers and cardiac defibrillators (ICD) have been designed to treat cardiac arrhythmias. These arrhythmias often lead to life-threatening conditions. Numerous studies have shown the benefits on survival and quality of life of these cardiac rhythm management (CRM) devices. These devices rely on a transvenous intracardiac lead for sensing and to deliver therapy. Unfortunately the lead is the Achilles-heal of this therapy. Most complications of CRM therapy are related to implantation, malfunction or infection of these leads. Some complications even have fatal consequences. This is obviously in contradiction with one of the most important rules in medicine: First Do No Harm!
This thesis describes the introduction of three new technologies designed to overcome these complications. In part I the initial experience in The Netherlands is presented with the wearable cardiac defibrillator. In part II the introduction and further widespread use of the subcutaneous ICD is discussed together with chapters on new implantation techniques and on management of inappropriate therapy. In part III the clinical experience with two different leadless pacemakers is being analyzed and in part IV successful animal experiments with a system consisting of an S-ICD communicating with a leadless pacemaker open the door to a new era for cardiac rhythm management. In this new era leads will probably not be necessary anymore to treat cardiac arrhythmias which will lead to less complications and better patient outcome.