The Neglected Parameter: Tricuspidal E Wave Deceleration Time as Predictor of Atrioventricular Synchrony in VDD Leadless Pacemakers.

Leadless pacemakers as the Medtronic Micra AV, have improved cardiac pacing by reducing complications associated with traditional systems. However, achieving high atrioventricular synchrony (AVS) remains a challenge, especially in patients with a high pacing burden. This prospective study enrolled 30 patients to assess the role of echocardiographic parameters in predicting AVS postimplantation. AVS was evaluated via 24-h Holter monitoring, with a median AVS of 67.9% ± 9.6%. Right atrial function, particularly the tricuspidal E wave deceleration time, emerged as the only independent predictor of AVS (p = 0.03), with an AUC of 0.77. These findings suggest that pre-implantation echocardiographic assessment of right atrial parameters could aid in selecting patients who would benefit most from Micra AV. Further studies with larger cohorts and extended follow-ups are warranted.