Ensuring compatibility: A 3-stage screening strategy for leadless atrial pacemaker implantation with a pre-existing subcutaneous defibrillator

The advent of subcutaneous implantable cardioverter-defibrillator (S-ICD) and leadless pacemakers (LPs) has enabled a completely transvenous lead-free strategy for patients requiring bradycardia pacing and defibrillation.1,2 However, this approach requires careful assessment of device-device interaction, particularly pacing-induced S-ICD oversensing, which may result in ineligible screening or inappropriate shocks.[3-5] Previous studies have shown that pacing site, pacing output, and R/T-wave morphology significantly influence sensing eligibility.