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Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

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Mapping the future: Predictive value of commanded electrogram parameters for the pacing performance in

Takehiro Nomura¹, Kosuke Onodera¹, Daiki Kumazawa¹

¹Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai, Miyagi, Japan.

Heart Rhythm O2

|October 31, 2025

Summary

Commanded electrograms (cEGMs) like current of injury and QRS amplitude can predict midterm pacing capture threshold (PCT) after Aveir VR leadless pacemaker implantation. These electrogram parameters can guide fixation strategies for better outcomes.

Keywords:

Amplitude Bradycardia Current of injury Electrocardiogram Leadless pacemaker Pacing threshold

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Published on: November 7, 2019

Area of Science:

Cardiology
Medical Devices
Electrophysiology

Background:

Leadless pacemaker implantation using Aveir VR technology relies on commanded electrograms (cEGMs) to assess fixation site suitability.
Clinical data on the predictive value and optimal cutoff values of cEGMs for pacing capture threshold (PCT) after implantation are limited.

Purpose of the Study:

To investigate the association between midterm pacing capture threshold (PCT) and cEGM parameters following Aveir VR implantation.
To determine the predictive value of cEGM parameters for successful pacemaker fixation.

Main Methods:

Retrospective analysis of 74 patients undergoing Aveir VR implantation with analyzable cEGM data.
Measurement of cEGM parameters (QRS amplitude, duration, current of injury) in premapping and tether modes.
Correlation and receiver operating characteristic analyses to identify optimal cutoff values for predicting elevated PCT (>1.5 V/0.4 ms).

Main Results:

Current of injury (COI) and QRS amplitude showed significant correlations with PCT.
Optimal COI cutoff values were >2.0 mV (AUC 0.668-0.715), associated with higher PCT.
Optimal QRS amplitude cutoff values were >5.0 mV (premapping) and >4.0 mV (tether) (AUC 0.771-0.840), strongly predicting elevated PCT.

Conclusions:

Pre-fixation cEGM parameters, specifically COI and QRS amplitude, are valuable predictors of midterm PCT after Aveir VR implantation.
Utilizing these electrogram parameters can potentially enhance leadless pacemaker fixation strategies and improve procedural success.