Leadless atrioventricular synchronous pacing in an outpatient setting: Early lessons learned on factors affecting atrioventricular synchrony

Abstract

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Ambulatory atrioventricular synchronous pacing over time using a leadless ventricular pacemaker: Primary results from the AccelAV study

“…With this programming, ambulatory AVS percentage increased significantly from 71.9% to 82.6%, similar to AVS at rest with the most pronounced increase during elevated sinus rates between 80 and 110 bpm. Similar findings were reported by Neugebauer et al 11 in an outpatient setting where the authors were able to improve median AVS with a second optimization session occurring between 1-3 months after implantation.…”

Symphony to leadless pacing—An Ode to Joy

“…Most importantly, their data confirms and is in line with recent reports, 8,9 that the success in achieving AV synchrony in a real-world setting may be lower than the MARVEL 2 clinical trial. The results also emphasize the importance of active programming changes which can significantly improve AV synchrony following an optimization postimplantation.…”

“…Critical programming changes made by performing a manual atrial mechanical (MAM) test while disabling the features that automatically affect these include adjusting the PVAB, A3/A4 windows, and A3/A4 thresholds, and turning off the AV conduction mode (VVI+) in those with complete heart block and escape >40 bpm. The authors and others 8,9 have identified helpful examples of troubleshooting these interval timings and thresholds for optimizing AV synchrony, which an implanter must be familiar with to successfully manage patients with leadless AV synchronous devices. Critically, while performing a MAM test, a key prerequisite for successful interpretation of device tracings is the inclusion of an optimal electrocardiogram tracing.…”

Evolution of tricuspid valve regurgitation after implantation of a leadless pacemaker: A single center experience, systematic review, and meta‐analysis

“…However, LLPMs may—with unknown frequency—still adhere to the tricuspid valve and subvalvular apparatus, posing a challenge if device extraction is performed 25 . Moreover, a functional TR component induced by the non‐physiologic RV stimulation may remain, despite the recently introduced more physiologic LLPMs (i.e., atrio‐ventricular synchronous LLPMs 26 ).…”