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. 2024 Mar 1;26(3):euae051.
doi: 10.1093/europace/euae051.

Aveir VR real-world performance and chronic pacing threshold prediction using mapping and fixation electrical data

Mark T K Tam  1 , Yuet-Wong Cheng  2 , Joseph Y S Chan  3 , Chin-Pang Chan  3 , Alex C K Au  3 , Katie W S Fan  3 , Thomas M Y Chim  2 , Wan-Ying Kwok  2 , Fuk-Kei Fong  3 , Angel Lai  1 , Guang-Ming Tan  1 , Bryan P Yan  1
Affiliations

Aveir VR real-world performance and chronic pacing threshold prediction using mapping and fixation electrical data

Mark T K Tam et al. Europace. .

Abstract

Aims: Aveir VR performance and predictors for its pacing threshold (PCT) in a real-world cohort were investigated.

Methods: Electrical measurements at various stages of an Aveir VR implant were prospectively collected. Predictors for 3-month PCT were studied. A retrospective cohort of consecutive 139 Micra implants was used to compare the PCT evolution. High PCT was defined as ≥1.5 V, using a pulse width of 0.4 ms for Aveir and 0.24 ms for Micra. Excellent PCT was defined as ≤0.5 V at the respective pulse width.

Results: Among the 123 consecutive Aveir VR implant attempts, 122 (99.2%) were successful. The majority were of advanced age (mean 79.7) and small body size (mean BSA 1.60). Two patients (1.6%) experienced complications, including one pericardial effusion after device reposition and one intraoperative device dislodgement. Eighty-eight patients reached a 3-month follow-up. Aveir 3-month PCT was correlated with impedance at mapping (P = 0.015), tether mode (P < 0.001), end-of-procedure (P < 0.001), and mapping PCT (P = 0.035), but not with PCTs after fixation (P > 0.05). Tether mode impedance >470 ohms had 88% sensitivity and 71% specificity in predicting excellent 3-month PCT. Although it is more common for Aveir to have high PCT at end of procedure (11.5% for Aveir and 2.2% for Micra, P = 0.004), the rate at 3 months was similar (2.3% for Aveir and 3.1% for Micra, P = 1.000).

Conclusion: Aveir VR demonstrated satisfactory performance in this high-risk cohort. Pacing thresholds tend to improve to a greater extent than Micra after implantation. The PCT after fixation, even after a waiting period, has limited predictive value for the chronic threshold. Low-mapping PCT and high intraoperative impedance predict chronic low PCT.

Keywords: Aveir; Leadless pacemaker; Micra; Pacing threshold; Real-world data.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical Abstract
Graphical Abstract
Aveir VR pacing threshold tended to improve after implant, while Micra stayed the same. Intraoperative impedance is a good predictor for chronic threshold, while intraoperative threshold was not.
Figure 1
Figure 1
Electrical measurement of Aveir at various stages of implant and follow-up.
Figure 2
Figure 2
Receiver operative characteristic analysis on 3-month pacing threshold and intraoperative impedance and pacing threshold. The area under the curve for impedance at mapping, tether mode, and end of procedure was 0.72, 0.82, and 0.80, respectively, indicating good predicting power. The area under the curve for pacing threshold at mapping, tether mode, and end of procedure was 0.65, 0.56, and 0.64, respectively, indicating poor predicting power. ROC, receiver operative characteristic.
Figure 3
Figure 3
Scatter plot of 3-month pacing threshold against impedance at tether mode. Tether mode impedance >470 ohms had 88% sensitivity and 71% specificity in predicting excellent 3-month pacing threshold.
See this image and copyright information in PMC

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