Ambulatory atrioventricular synchronous pacing over time using a leadless ventricular pacemaker: Primary results from...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Accelerometer-based, mechanically timed atrioventricular synchrony (AVS) has been shown to be feasible with leadless ventricular pacemakers.
• Leadless pacing technology aims to improve patient outcomes and reduce complications associated with traditional pacing systems.

Purpose of the Study:

• To evaluate the performance of a leadless ventricular pacemaker utilizing accelerometer-based algorithms for AVS pacing.
• To characterize the effectiveness of accelerometer-driven AVS in patients with complete atrioventricular block and normal sinus function.

Main Methods:

• A prospective, single-arm study (AccelAV) enrolled 152 patients implanted with the Micra AV leadless pacemaker.
• The study focused on characterizing resting and ambulatory AVS at 1 month in 54 patients with complete AV block and normal sinus function.
• Quality of life was assessed using the EQ-5D-3L questionnaire, and device performance was monitored for 3 months.

Main Results:

• Among 54 patients with complete AV block and normal sinus function, mean resting AVS was 85.4% and ambulatory AVS was 74.8% at 1 month.
• Programming optimization in 20 patients improved mean ambulatory AVS to 82.6% (a 10.5% increase, P <.001).
• Quality of life significantly improved from pre-implant to 3 months (P = .031), with no device upgrades required.

Conclusions:

• Accelerometer-based mechanical atrial sensing via a leadless pacemaker significantly enhances quality of life in selected AV block patients.
• AVS performance remained stable through 3 months, demonstrating the reliability of this leadless pacing approach.
• No patients required upgrades to dual-chamber pacemakers, highlighting the potential of leadless AVS technology.