loading page

A Real-world Experience of Atrioventricular Synchronous Pacing with Leadless Ventricular Pacemakers
  • +11
  • Gurukripa Kowlgi,
  • Andrew Tseng,
  • Nathan Tempel,
  • Mark Henrich,
  • Kalpathi Venkatachalam,
  • Luis Scott,
  • Win-Kuang Shen,
  • Abhishek Deshmukh,
  • Malini Madhavan,
  • Hon-Chi Lee,
  • Samuel Asirvatham,
  • Paul Friedman,
  • Yong-Mei Cha,
  • Siva Mulpuru
Gurukripa Kowlgi
Mayo Clinic
Author Profile
Andrew Tseng
Mayo Clinic
Author Profile
Nathan Tempel
Mayo Clinic
Author Profile
Mark Henrich
Mayo Clinic Minnesota
Author Profile
Kalpathi Venkatachalam
Mayo Clinic
Author Profile
Luis Scott
Mayo Clinic Arizona
Author Profile
Win-Kuang Shen
Mayo Clinic
Author Profile
Abhishek Deshmukh
Mayo Clinic
Author Profile
Malini Madhavan
Mayo Clinic
Author Profile
Hon-Chi Lee
Mayo Clinic
Author Profile
Samuel Asirvatham
Mayo Clinic
Author Profile
Paul Friedman
Mayo Clinic
Author Profile
Yong-Mei Cha
Mayo Clinic
Author Profile
Siva Mulpuru
Mayo Clinic
Author Profile

Abstract

Aims: The MicraTM transcatheter pacing system (TPS) (Medtronic) is the only leadless pacemaker that promotes atrioventricular (AV) synchrony via accelerometer-based atrial sensing. Data regarding the real-world experience with this novel system are currently lacking. We sought to characterize patients undergoing MicraTM -AV implants, describe percentage AV synchrony achieved, and analyze the causes for suboptimal AV synchrony. Methods: In this retrospective cohort study, electronic medical records from 56 consecutive patients undergoing MicraTM -AV implants at the Mayo Clinic sites in Minnesota, Florida, and Arizona with a minimum follow-up of 3 months were reviewed. Demographic data, comorbidities, echocardiographic data, and clinical outcomes were compared among patients with and without atrial synchronous-ventricular pacing (AsVP) ≥70%. Results: Fifty-six percent of patients achieved AsVP ≥70%. Patients with adequate AsVP had smaller body mass indices, a lower proportion of congestive heart failure and pulmonary hypertension. Echocardiographic parameters and procedural characteristics were similar across the two groups. Active device troubleshooting was associated with higher AsVP. The likely reasons for low AsVP were persistent atrial arrhythmias, small A4-wave amplitude, and inadequate device reprogramming. Importantly, in patients with low AsVP, subjective clinical worsening was not noted during follow-up. Conclusion: With the increasing popularity of leadless PM, it is paramount for device implanting teams to be familiar with common predictors of AV synchrony and troubleshooting with MicraTM -AV devices.

Peer review status:ACCEPTED

02 Nov 2021Submitted to Journal of Cardiovascular Electrophysiology
15 Nov 2021Submission Checks Completed
15 Nov 2021Assigned to Editor
17 Nov 2021Reviewer(s) Assigned
28 Nov 2021Review(s) Completed, Editorial Evaluation Pending
30 Nov 2021Editorial Decision: Revise Minor
02 Jan 20221st Revision Received
05 Jan 2022Submission Checks Completed
05 Jan 2022Assigned to Editor
05 Jan 2022Reviewer(s) Assigned
17 Jan 2022Review(s) Completed, Editorial Evaluation Pending
17 Jan 2022Editorial Decision: Accept