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Behavior of AV synchrony pacing mode in a leadless pacemaker during variable AV conduction and arrhythmias

Garweg C 1 , Khelae SK 2 , Chan JYS 3 , Chinitz L 4 , Ritter P 5 , Johansen JB 6 Show all authors , Sagi V 7 , Epstein LM 8 , Piccini JP 9 , Pascual M 10 , Mont L 11 , Willems R 1 , Splett V 12 , Stromberg K 12 , Sheldon T 12 , Kristiansen N 13 , Steinwender C 14

Affiliations 

  • 1 Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
  • 2 Department of Electrophysiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
  • 3 Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
  • 4 Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
  • 5 Department of Electrophysiology and Cardiac Stimulation, Hôpital Haut- Lévêque-CHU de Bordeaux, Pessac, France
  • 6 Department of Cardiology, Odense University Hospital, Odense, Denmark
  • 7 Baptist Heart Specialists, Baptist Medical Center, Jacksonville, Florida, USA
  • 8 Department of Electrophysiology, North Shore University Hospital, Manhasset, New York, USA
  • 9 Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
  • 10 Miami Cardiac & Vascular Institute, Baptist Hospital, Miami, Florida, USA
  • 11 Institut Clinic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
  • 12 Medtronic, Inc., Minneapolis, Minnesota, USA
  • 13 Medtronic Bakken Research Center, Maastricht, The Netherlands
  • 14 Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
J Cardiovasc Electrophysiol, 2021 07;32(7):1947-1957.
PMID: 33928713 DOI: 10.1111/jce.15061

Abstract

INTRODUCTION: MARVEL 2 assessed the efficacy of mechanical atrial sensing by a ventricular leadless pacemaker, enabling a VDD pacing mode. The behavior of the enhanced MARVEL 2 algorithm during variable atrio-ventricular conduction (AVC) and/or arrhythmias has not been characterized and is the focus of this study.

METHODS: Of the 75 patients enrolled in the MARVEL 2 study, 73 had a rhythm assessment and were included in the analysis. The enhanced MARVEL 2 algorithm included a mode-switching algorithm that automatically switches between VDD and ventricular only antibradycardia pacing (VVI)-40 depending upon AVC status.

RESULTS: Forty-two patients (58%) had persistent third degree AV block (AVB), 18 (25%) had 1:1 AVC, 5 (7%) had variable AVC status, and 8 (11%) had atrial arrhythmias. Among the 42 patients with persistent third degree AVB, the median ventricular pacing (VP) percentage was 99.9% compared to 0.2% among those with 1:1 AVC. As AVC status changed, the algorithm switched to VDD when the ventricular rate dropped less than 40 bpm. During atrial fibrillation (AF) with ventricular response greater than 40 bpm, VVI-40 mode was maintained. No pauses longer than 1500 ms were observed. Frequent ventricular premature beats reduced the percentage of AV synchrony. During AF, the atrial signal was of low amplitude and there was infrequent sensing.

CONCLUSION: The mode switching algorithm reduced VP in patients with 1:1 AVC and appropriately switched to VDD during AV block. No pacing safety issues were observed during arrhythmias.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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