Navigating the Lead Paradox: Successful Co-Implantation of Cardiac Contractility Modulation Device and a Micra Leadless Pacemaker.

BACKGROUND

Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) can lead to refractory heart failure. A "lead paradox" occurs when patients with a Micra leadless pacemaker require lead-based Cardiac Contractility Modulation (CCM) therapy.

CASE SUMMARY: We detail the first co-implantation of CCM and Micra devices in a 78-year-old male with ATTRwt-CA and NYHA III heart failure. A multi-view fluoroscopic technique ensured spatial separation, while specific device programming mitigated electrical crosstalk post-procedure.

CONCLUSION

At 1 year, the patient stabilized to NYHA Class II without further hospitalizations. This dual-device strategy is a feasible and safe technical roadmap for this complex clinical problem.