Background
Performance of the leadless pacemaker capable of atrioventricular (AV) synchronous
pacing in de novo patients warrants further investigation.
Objective
The aims of this study were to assess what programming changes are needed to achieve
proper atrial tracking and to study the percentage of AV synchrony (AVS) the device
can provide under real-world conditions.
Methods
Consecutive patients undergoing Micra AV implantation between June 2020 and November
2021 were studied. Reprogramming of atrial sensing parameters during follow-up was
performed by following device counters. AVS was studied with an ambulatory 24-hour
Holter monitor and automatically analyzed by an electrocardiogram delineation system.
The primary end point was AVS ≥85% of total cardiac cycles during 24-hour Holter electrocardiogram
monitoring.
Results
Thirty-one patients who remained in VDD mode were studied, and all of them required
manual reprogramming. The automatic A3 window end was deactivated, and a fixed and
short value was set in all patients throughout follow-up. AVS significantly increased
from 68.7% ± 14.7% at 24-hour follow-up to 83.9% ± 7.4% at 1-month visit (P = .001). At 1-month visit, shorter A3 window end time (P = .019), higher A4 threshold (P = .011), and deactivation of the automatic A3 window (P = .054) were independently related to higher AVS. A total of 2,291,953 Holter-recorded
cardiac cycles were analyzed. Median AVS during 24-hour daily activities was 87.6%
(interquartile range 84.5%–90.6%). Twenty of 26 patients (79.6%) reached AVS ≥85%
of cardiac cycles.
Conclusion
High rates of AVS can be achieved in real-world patients undergoing leadless pacing.
Manual reprogramming of the atrial sensing parameters is essential to optimize mechanically
sensed atrial tracking.
Keywords
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Article info
Publication history
Published online: August 08, 2022
Footnotes
Funding Sources: This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosures: Drs Briongos-Figuero and Estévez-Paniagua report personal fees from Medtronic and Boston Scientific. The rest of the authors report no conflicts of interest.
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