Leadless pacing Towards modular, extravascular device therapy

This thesis focuses on the development and optimal clinical implementation of single-chamber leadless pacemakers (LPs), the first dual-chamber LP, and other innovative devices. As such, it aimed to contribute to making modular, extravascular heart rhythm therapy a reality for all who may benefit from it, and to improve patient selection.
Part I focuses on single-chamber ventricular leadless pacing and includes long-term safety and efficacy outcomes (Chapter 2), real-world battery longevity (Chapter 3), outcomes of using LPs in a population with a previous device infection (Chapter 4), outcomes of a novel method of intra-operative implantation (Chapter 5), and a histopathologic assessment of encapsulating tissues (Chapter 6). Part II includes two studies on dual-chamber leadless pacing: the first clinical results (Chapter 7), and a study on pacing burden in patients with different pacing indications in order to select candidates for this therapy (Chapter 8). Part III focuses on the advancement of extravascular rhythm management as a whole, with long-term preclinical experience of a device combination consisting of a subcutaneous implantable cardioverter defibrillator (S-ICD) and LP (Chapter 9), a study comparing tricuspid regurgitation after S-ICD and transvenous ICD implantation (Chapter 10), an overview of the real-world adoption of S-ICDs and LPs in the Netherlands (Chapter 11), and the description of a nationwide dedicated prospective registry (Chapter 12).