Anatomical, Biomechanical, and End-of-Life Considerations for Emergent Cardiac Pacing Technologies

Abstract

Over 600,000 permanent pacing systems are implanted each calendar year as the primary therapy for symptomatic bradycardia. Innovations in pacing technology have rapidly expanded the indications for this life-saving therapy, while reducing complication rates. This thesis examined three prongs of emergent pacing technologies: leadless pacing, epicardial/extravascular pacing, and physiologic pacing through the bundle of His. First, I quantitatively evaluated the likely target anatomies for next-generation pacing systems. Then, anatomic data was supplemented with biomechanics, to provide the foundation upon which next-generation leadless pacemaker fixation mechanisms may be built. Finally, I investigated some of the challenges of extracting leadless pacing systems. The data in this thesis provided a substrate for the design and implementation of next-generation pacing systems.