A novel combination of cardiac rhythm management (CRM) devices can deliver both bradycardia pacing support and antitachycardia pacing (ATP).

The Boston Scientific (Natick, MA, USA) mCRM Modular Therapy System consists of two CRM devices designed to work together to coordinate therapy - the EMBLEM MRI subcutaneous implantable defibrillator (S-ICD) system, which is a proven treatment option for the prevention of sudden cardiac death (SCD), and the investigational EMPOWER modular pacing system (MPS), a leadless implantable pacemaker designed to terminate episodes of fast, abnormal heart rates.

The EMBLEM S-ICD System uses a subcutaneous electrode to effectively sense, discriminate, and convert ventricular fibrillation (VF) and ventricular tachycardia (VT) for arrhythmia treatment. A second feature, the atrial fibrillation (AF) monitor, helps physicians make more informed treatment decisions for their patients. The S-ICD System is labeled safe for use in a MRI setting when conditions of use are met. The EMPOWER MPS, currently under investigational use, is designed to complement the S-ICD System.

“Since the EMPOWER MPS device can be delivered percutaneously via a minimally invasive approach without the use of leads, the mCRM System could preserve many of the benefits of the S-ICD system while offering an option for patients who subsequently develop a pacing requirement,” said Kenneth Stein, MD, senior vice president and chief medical officer of rhythm management and global health policy at Boston Scientific. “The components of the system are designed to work in concert with each other, giving physicians the ability to provide personalized patient care today while keeping options open in the future.”

ATP has long been recognized as a way to pace-terminate certain types of arrhythmias, particularly slow monomorphic ventricular tachycardia (VT) involving a reentry circuit, by delivering a short pacing stimuli to the heart at a rate faster than the tachycardia. The idea is take an advantage of the gap between successive activations when the myocardium can receive an activation wavefront that collides with one of the preexisting tachycardia in order to terminate it. 

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