Chair Suneet Mittal (New York, US) led discussions with Case Operator Devi Nair (Jonesboro, US) and panellists James Ip (New York, US) and Dinesh Sharma (Naples, US). The session focused on leadless cardiac resynchronisation therapy (CRT) using the WiSE CRT system, which provides left ventricular (LV) endocardial pacing synchronised with an existing right ventricular (RV) pacemaker. Dinesh Sharma presented a case involving an 81-year-old patient with end-stage renal disease and recurrent heart failure, demonstrating the use of the WiSE CRT system alongside a Micra AV pacemaker. The procedure involved transcatheter electrode implantation via a transseptal or retrograde aortic approach, guided by intracardiac echocardiography (ICE) and fluoroscopy.

Discussions covered the importance of optimal electrode positioning for effective pacing and challenges such as achieving proper synchronisation with RV pacing. The faculty reviewed data from trials, including the SOL CRT study, which showed improvements in LV function and reduction in QRS duration. Challenges in procedural timing, electrode anchoring, and future developments, such as left bundle area pacing and rechargeable battery technology, were also highlighted. The session concluded with optimism about the potential of leadless CRT in improving outcomes for patients with complex cardiovascular conditions.