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Atrioventricular Synchronous Pacing Using a Leadless Ventricular Pacemaker

Open access
Steinwender, Clemens, Khelae, Surinder Kaur, Garweg, Christophe, Chan, Joseph Yat Sun, Ritter, Philippe, Johansen, Jens Brock, Sagi, Venkata, Epstein, Laurence M., Piccini, Jonathan P., Pascual, Mario, Mont, Lluis, Sheldon, Todd, Splett, Vincent, Stromberg, Kurt, Wood, Nicole, Chinitz, Larry·2020·JACC: Clinical Electrophysiology

Abstract

OBJECTIVES: This study reports on the performance of a leadless ventricular pacemaker with automated, enhanced accelerometer-based algorithms that provide atrioventricular (AV) synchronous pacing. BACKGROUND: Despite many advantages, leadless pacemakers are currently only capable of single-chamber ventricular pacing. METHODS: The prospective MARVEL 2 (Micra Atrial tRacking using a Ventricular accELerometer 2) study assessed the performance of an automated, enhanced accelerometer-based algorithm downloaded to the Micra leadless pacemaker for up to 5 h in patients with AV block. The primary efficacy objective was to demonstrate the superiority of the algorithm to provide AV synchronous (VDD) pacing versus VVI-50 pacing in patients with sinus rhythm and complete AV block. The primary safety objective was to demonstrate that the algorithm did not result in pauses or heart rates of >100 beats/min. RESULTS: Overall, 75 patients from 12 centers were enrolled; an accelerometer-based algorithm was downloaded to their leadless pacemakers. Among the 40 patients with sinus rhythm and complete AV block included in the primary efficacy objective analysis, the proportion of patients with ≥70% AV synchrony at rest was significantly greater with VDD pacing than with VVI pacing (95% vs. 0%; p < 0.001). The mean percentage of AV synchrony increased from 26.8% (median: 26.9%) during VVI pacing to 89.2% (median: 94.3%) during VDD pacing. There were no pauses or episodes of oversensing-induced tachycardia reported during VDD pacing in all 75 patients. CONCLUSIONS: Accelerometer-based atrial sensing with an automated, enhanced algorithm significantly improved AV synchrony in patients with sinus rhythm and AV block who were implanted with a leadless ventricular pacemaker. (Micra Atrial Tracking Using a Ventricular Accelerometer 2 [MARVEL 2]; NCT03752151).

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Metadata

Authors
Steinwender, C., Khelae, S. K., Garweg, C., Chan, J. Y. S., Ritter, P., Johansen, J. B., Sagi, V., Epstein, L. M., Piccini, J. P., Pascual, M., Mont, L., Sheldon, T., Splett, V., Stromberg, K., Wood, N., & Chinitz, L.
Venue
JACC: Clinical Electrophysiology
Publisher
Elsevier BV
Published
2020-01
Volume
6
Issue
1
Pages
94-106
ISSN
2405-500X (ISSN-L)
OpenAlex
W2987720593
Cited by
257
References
12
FWCI
19.40
Type
journal article
Language
en
Open access
hybrid

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CoChat. (2026). Citation check: Atrioventricular Synchronous Pacing Using a Leadless Ventricular Pacemaker. https://app.cochat.ai/papers/10.1016/j.jacep.2019.10.017
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Steinwender, C., Khelae, S. K., Garweg, C., Chan, J. Y. S., Ritter, P., Johansen, J. B., Sagi, V., Epstein, L. M., Piccini, J. P., Pascual, M., Mont, L., Sheldon, T., Splett, V., Stromberg, K., Wood, N., & Chinitz, L. (2020). Atrioventricular Synchronous Pacing Using a Leadless Ventricular Pacemaker. JACC: Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2019.10.017

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