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. 2021 Aug 23;2(5):455-462.
doi: 10.1016/j.hroo.2021.08.003. eCollection 2021 Oct.

Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience

Kelly Arps  1 , Jonathan P Piccini  1   2 , Rebecca Yapejian  1 , Rhonda Leguire  1 , Brenda Smith  1 , Sana M Al-Khatib  1   2 , Tristram D Bahnson  1 , James P Daubert  1 , Donald D Hegland  1 , Kevin P Jackson  1 , Larry R Jackson 2nd  1   3 , Robert K Lewis  1   3 , Sean D Pokorney  1   2 , Albert Y Sun  1   3 , Kevin L Thomas  1   2 , Camille Frazier-Mills  1
Affiliations

Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience

Kelly Arps et al. Heart Rhythm O2. .

Abstract

Background: Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described.

Objective: To describe pacing outcomes and programming changes with AV-synchronous leadless pacemakers in clinical practice.

Methods: Consecutive patients without persistent atrial fibrillation who received an AV-synchronous leadless pacemaker and completed follow-up between February 2020 and April 2021 were included. We evaluated tracking index (atrial mechanical sense followed by ventricular pace [AM-VP] divided by total VP), total AV synchrony (sum of AM-ventricular sense [AM-VS], AM-VP, and AV conduction mode switch), use of programming optimization, and improvement in AV synchrony after optimization.

Results: Fifty patients met the inclusion criteria. Mean age was 69 ± 16.8 years, 24 (48%) were women, 24 (48%) had complete heart block, and 17 (34%) required ≥50% pacing. Mean tracking index was 41% ± 34%. Thirty-five patients (70%) received ≥1 programming change. In 36 patients with 2 follow-up visits, tracking improved by +9% ± 28% (P value for improvement = .09) and +18% ± 19% (P = .02) among 15 patients with complete heart block. Average total AV synchrony increased from 89% [67%, 99%] to 93% [78%, 100%] in all patients (P = .22), from 86% [52%, 98%] to 97% [82%, 99%] in those with complete heart block (P = .04), and from 73% [52%, 80%] to 78% [70%, 85%] in those with ≥50% pacing (P = .09).

Conclusion: In patients with AV-synchronous leadless pacemakers, programming changes are frequent and are associated with increased atrial tracking and increased AV synchrony in patients with complete heart block.

Keywords: Atrioventricular synchrony; Complete heart block; Leadless pacemaker; Mechanical atrial sensing; Pacemaker programming.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Cohort selection. AV = atrioventricular.
Figure 2
Figure 2
Cumulative pacing burden and tracking index for each patient at first follow-up. For each patient, pacing percentages representing successful tracking of atrial mechanical sensing (AM-VP) and nontracked ventricular pacing (VP) are plotted. Tracking index = AM-VP / total VP.
Figure 3
Figure 3
Change in pacing burden and tracking index after optimization. Average tracking efficiency metrics at first visit and second visit for patients who completed 2 visits. Abbreviations as in Figure 1.
Figure 4
Figure 4
Programming optimization and improvement in tracking index. Tracking index at each visit along with parameter changes performed at first visit are displayed. Patients with 2 visits and at least 0.1% pacing were included. Those who were in a nontracking mode at either visit were excluded. PVAB = postventricular atrial blanking; PVARP = postventricular atrial refractory period.
See this image and copyright information in PMC

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