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

J Cardiovasc Electrophysiol. 2026 Feb;37(2):434-437. doi: 10.1111/jce.70244. Epub 2026 Jan 9.

Abstract

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.

Keywords: Cardiac Contractility Modulation; cardiac amyloidosis; case report; device–device interaction; electrophysiology technique; leadless pacemaker.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amyloid Neuropathies, Familial* / complications
  • Amyloid Neuropathies, Familial* / diagnosis
  • Amyloid Neuropathies, Familial* / physiopathology
  • Amyloid Neuropathies, Familial* / therapy
  • Cardiac Pacing, Artificial*
  • Cardiomyopathies* / complications
  • Cardiomyopathies* / diagnosis
  • Cardiomyopathies* / physiopathology
  • Cardiomyopathies* / therapy
  • Equipment Design
  • Heart Failure* / diagnosis
  • Heart Failure* / etiology
  • Heart Failure* / physiopathology
  • Heart Failure* / therapy
  • Heart Rate
  • Humans
  • Male
  • Myocardial Contraction*
  • Pacemaker, Artificial*
  • Treatment Outcome
  • Ventricular Function, Left*

Supplementary concepts

  • Amyloidosis, Hereditary, Transthyretin-Related