University Hospitals Leuven, Leuven, Belgium.
Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA.
J Cardiovasc Electrophysiol. 2023 Jan;34(1):197-206. doi: 10.1111/jce.15726. Epub 2022 Nov 15.
Micra atrioventricular (AV) provides leadless atrioventricular synchronous pacing by sensing atrial contraction (A4 signal). Real-world operation and reliability of AV synchrony (AVS) assessment using device data have not been described. The purposes of this study were to (1) assess the correlation between AVS and atrial mechanical sensed-ventricular pacing (AM-VP) percentages in patients with permanent high-degree AV block and (2) report on the real-world effectiveness of Micra AV.
The correlation between ECG-determined AVS in-clinic and device-collected %AM-VP was assessed using data from 40 patients with high-degree AV block enrolled in the Micra Atrial tRacking using a Ventricular AccELerometer (MARVEL) 2 study. A retrospective analysis to assess continuously-sampled %AM-VP since last session, device programming, and electrical parameters was performed using Micra AV transmissions from the Medtronic CareLink database. Patients with transmissions ≥180 days postimplant were included.
Among the 40 MARVEL 2 AV block patients with a median %VP of 99.7%, AVS was highly correlated with AM-VP (median AVS 87.1%, median AM-VP 79.1%; R = 0.764, p < .001). The CareLink cohort included 4384 patients programmed to VDD mode. The mean A4 amplitude was 2.3 ± 1.8 m/s at implant and 2.3 ± 1.6 m/s at 28 weeks. In patients with %VP >90% (n = 1662), the median %AM-VP was 74.7%. For the full cohort, median %VP was 65.6% and median projected battery longevity was 10.5 years.
In patients with a high pacing burden, %AM-VP provides a reasonable estimation of AVS. The first large real-world analysis of Micra AV patients with >90% VP showed stable atrial sensing over time with a median %AM-VP, a correlate of AVS, of 74.7%.
Micra 房室（AV）通过感知心房收缩（A4 信号）提供无导线房室同步起搏。尚未描述使用设备数据进行 AV 同步（AVS）评估的实际操作和可靠性。本研究的目的是：（1）评估永久性高度房室传导阻滞患者中 AVS 与心房机械感知心室起搏（AM-VP）百分比的相关性；（2）报告 Micra AV 的真实世界疗效。
使用来自 40 名高度房室传导阻滞患者的 MARVEL 2 研究中的数据评估心电图确定的 AVS 与设备采集的 %AM-VP 之间的相关性。使用 Medtronic CareLink 数据库中的 Micra AV 传输进行回顾性分析，以评估自上次会议以来的连续采样 %AM-VP、设备编程和电参数。包括植入后传输时间≥180 天的患者。
在 40 名 MARVEL 2 AV 阻滞患者中，中位 %VP 为 99.7%，AVS 与 AM-VP 高度相关（中位 AVS 为 87.1%，中位 AM-VP 为 79.1%；R = 0.764，p < .001）。CareLink 队列包括 4384 名编程为 VDD 模式的患者。植入时 A4 振幅的平均值为 2.3±1.8 m/s，28 周时为 2.3±1.6 m/s。在 %VP ＞90%的患者（n = 1662）中，中位 %AM-VP 为 74.7%。对于整个队列，中位 %VP 为 65.6%，中位预计电池寿命为 10.5 年。
在高起搏负担的患者中，%AM-VP 可合理估计 AVS。对 >90% VP 的 Micra AV 患者进行的首次大型真实世界分析显示，随着时间的推移，心房感知稳定，中位 %AM-VP（AVS 的相关指标）为 74.7%。
