Atrioventricular Synchronous Pacing Using a Leadless Ventricular Pacemaker: Results From the MARVEL 2 Study.

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Leadless pacemakers offer advantages but are limited to single-chamber ventricular pacing.
• Achieving atrioventricular (AV) synchrony is crucial for optimal cardiac function.

Purpose of the Study:

• To evaluate an automated, enhanced accelerometer-based algorithm for AV synchronous pacing in leadless pacemakers.
• To assess the performance of the Micra Atrial tRacking using a Ventricular accELerometer 2 (MARVEL 2) algorithm.

Main Methods:

• Prospective study (MARVEL 2) involving 75 patients with AV block.
• Downloaded an accelerometer-based algorithm to Micra leadless pacemakers.
• Compared AV synchronous (VDD) pacing with VVI pacing in patients with sinus rhythm and complete AV block.

Main Results:

• 95% of patients achieved ≥70% AV synchrony with VDD pacing versus 0% with VVI pacing (p < 0.001).
• Mean AV synchrony increased from 26.8% (VVI) to 89.2% (VDD).
• No pauses or tachycardia episodes were reported during VDD pacing.

Conclusions:

• Accelerometer-based atrial sensing with an automated algorithm significantly enhances AV synchrony.
• This technology improves pacing in patients with leadless ventricular pacemakers and AV block.
• The MARVEL 2 study demonstrates the efficacy and safety of this novel approach.