Correlation between AV synchrony and device collected AM-VP sequence counter in atrioventricular synchronous leadless pacemakers: A real-world assessment

• Type of Material: Article
• Authors: Christophe Garweg, University Hospital Leuven; Jonathan P Piccini, Duke University; Laurence M Epstein, Northwell Health; Camille Frazier-Mills, Duke University; Larry A Chinitz, NYU Langone Medical Center; Clemens Steinwender, Kepler University Hospital Linz; Kurt Stromberg, Medtronic Inc; Todd Sheldon, Medtronic Inc; Dedra H Fagan, Medtronic Inc; Mikhael F El-Chami, Emory University
• Language: English
• Date: 2022-11-15
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/jce.15726
• Title of Journal or Parent Work: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
• Volume: 34
• Issue: 1
• Start Page: 197
• End Page: 206
• Keywords: VDD pacing system; Cardiovascular System & Cardiology; Cardiac & Cardiovascular Systems; Micra AV; BLOCK; Life Sciences & Biomedicine; leadless pacemaker; VDD; AV synchrony; Science & Technology
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Introduction: Micra atrioventricular (AV) provides leadless atrioventricular synchronous pacing by sensing atrial contraction (A4 signal). Real-world operation and reliability of AV synchrony (AVS) assessment using device data have not been described. The purposes of this study were to (1) assess the correlation between AVS and atrial mechanical sensed-ventricular pacing (AM-VP) percentages in patients with permanent high-degree AV block and (2) report on the real-world effectiveness of Micra AV. Methods: The correlation between ECG-determined AVS in-clinic and device-collected %AM-VP was assessed using data from 40 patients with high-degree AV block enrolled in the Micra Atrial tRacking using a Ventricular AccELerometer (MARVEL) 2 study. A retrospective analysis to assess continuously-sampled %AM-VP since last session, device programming, and electrical parameters was performed using Micra AV transmissions from the Medtronic CareLink database. Patients with transmissions ≥180 days postimplant were included. Results: Among the 40 MARVEL 2 AV block patients with a median %VP of 99.7%, AVS was highly correlated with AM-VP (median AVS 87.1%, median AM-VP 79.1%; R2 = 0.764, p <.001). The CareLink cohort included 4384 patients programmed to VDD mode. The mean A4 amplitude was 2.3 ± 1.8 m/s2 at implant and 2.3 ± 1.6 m/s2 at 28 weeks. In patients with %VP >90% (n = 1662), the median %AM-VP was 74.7%. For the full cohort, median %VP was 65.6% and median projected battery longevity was 10.5 years. Conclusion: In patients with a high pacing burden, %AM-VP provides a reasonable estimation of AVS. The first large real-world analysis of Micra AV patients with >90% VP showed stable atrial sensing over time with a median %AM-VP, a correlate of AVS, of 74.7%.