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Kazawa S, Kazawa C, Sakaida T, Murakami H, Takada Y, Kusume T, Terasawa M, Tanaka N, Satomi K, Yazaki Y. Feasibility of a novel atrial mechanical sensing method for leadless atrioventricular synchronous pacing. J Cardiovasc Electrophysiol 2024; 35:1115-1120. [PMID: 38534012 DOI: 10.1111/jce.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/10/2024] [Accepted: 03/10/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Few studies have demonstrated a high degree of atrioventricular (AV) synchrony with a new leadless pacemaker called Micra AV. Our group previously reported a new and unique sensing method. We believe that this novel sensing method, "Simplified A3 method," might facilitate better AV synchrony than a conventional sensing method in almost all cases with Micra AV implantation. METHODS We conducted a non-randomized retrospective study comparing the two pacing methods at two centers. From December 1, 2021 to October 31, 2022, Micra AV was implanted for 32 patients at the two centers. Twenty of the 32 patients with sinus rhythm and complete AV block were included in this study. In Group 1, the conventional setting was programmed as follows: auto A3 threshold, auto A3 window-end (WE), and auto A4 threshold turned on during hospitalization. In Group 2, the "Simplified A3 method" was programmed as follows: auto A3 threshold and auto A3WE turned off. Instead, an intentionally prolonged A3WE (850-1000 ms) and low A3 threshold (A3 signal amplitude + 0.5-1.0 m/s2) were programmed. RESULTS Twenty patients were analyzed. In Group 2, AV synchrony (%AMVp) was significantly higher at the first outpatient clinic (63.0 ± 5.7% vs 81.0 ± 4.2%, p = .03). A3 threshold was significantly lower in Group 2 (5.9 ± 0.7 m/s2, p < .05 vs 2.3 ± 0.5 m/s2, p < .05). CONCLUSION Our novel sensing method might be a more feasible sensing method for obtaining higher AV synchrony than the conventional algorithm.
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Affiliation(s)
- Shuichiro Kazawa
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Chifumi Kazawa
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Tomoko Sakaida
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hidetaka Murakami
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yasuyuki Takada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Takahiro Kusume
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Muryo Terasawa
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yoshinao Yazaki
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
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Arps K, Li B, Allen JC, Alenezi F, Frazier-Mills C, Al-Khatib SM, Jackson KP, Jackson LR, Thomas KL, Piccini JP. Association of leadless pacing with ventricular and valvular function. J Cardiovasc Electrophysiol 2023; 34:2233-2242. [PMID: 37702140 DOI: 10.1111/jce.16046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/10/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Traditional transvenous pacemakers are associated with worsening tricuspid valve function due to lead-related leaflet impingement, as well as ventricular dysfunction related to electromechanical dyssynchrony from chronic right ventricular (RV) pacing. The association of leadless pacing with ventricular and valvular function has not been well established. We aimed to assess the association of leadless pacemaker placement with changes in valvular regurgitation and ventricular function. METHODS AND RESULTS Echocardiographic features before and after leadless pacemaker implant were analyzed in consecutive patients who received a leadless pacemaker with pre- and postprocedure echocardiography at Duke University Hospital between November 2014 and November 2019. Valvular regurgitation was graded ordinally from 0 (none) to 3 (severe). Among 54 patients, the mean age was mean age was 70.1 ± 14.3 years, 24 (44%) were women, and the most frequent primary pacing indication was complete heart block in 24 (44%). The median RV pacing burden was 45.4 (interquartile range [IQR] 3.5-97.0). On echocardiogram performed 8.9 months (IQR 4.5-14.5) after implant, there was no change in the average severity of tricuspid regurgitation (mean change 0.07 ± 1.15, p = .64) from pre-procedure echocardiogram. We observed a decrease in the average left ventricular ejection fraction (LVEF) (52.3 ± 9.3 to 47.9 ± 12.1, p = .0019) and tricuspid annular plane systolic excursion (TAPSE) (1.8 ± 0.6 to 1.6 ± 0.4, p = .0437). Thirteen patients (24%) had absolute drop in LVEF of ≥10%. CONCLUSION We did not observe short term worsening valvular function in patients with leadless pacemakers. However, consistent with the pathophysiologic impact of RV pacing, leadless pacing was associated with a reduction in biventricular function.
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Affiliation(s)
- Kelly Arps
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Bicong Li
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - John Carson Allen
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Fawaz Alenezi
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Camille Frazier-Mills
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sana M Al-Khatib
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin P Jackson
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Larry R Jackson
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin L Thomas
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
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Yiu KKH, Lau CP. Pacing induced tricuspid regurgitation: Does the lead matter? J Cardiovasc Electrophysiol 2023; 34:2243-2245. [PMID: 37870154 DOI: 10.1111/jce.16114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Kelvin Kai-Hang Yiu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Division of Cardiology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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Kazawa S, Satomi K, Kazawa C, Murakami H, Yazaki Y, Tanaka N. Novel method of atrial mechanical sensing for leadless atrioventricular synchronous pacing. HeartRhythm Case Rep 2022; 8:811-814. [PMID: 36620373 PMCID: PMC9811010 DOI: 10.1016/j.hrcr.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Shuichiro Kazawa
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan,Address reprint requests and correspondence: Dr Shuichiro Kazawa, Department of Cardiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo 193-0998, Japan.
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Chifumi Kazawa
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hidetaka Murakami
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yoshinao Yazaki
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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Brad Meers J, Snyder SW, Hasan R, Zheng Y, Davies J, Zaky A. Hemodynamic Instability Resulting From Pseudomalfunction of a Leadless Pacemaker During Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2021; 36:2588-2592. [PMID: 34895966 DOI: 10.1053/j.jvca.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022]
Affiliation(s)
- J Brad Meers
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
| | - Scott W Snyder
- Center of Educational Accountability, School of Education, University of Alabama at Birmingham, Birmingham, AL
| | - Ragib Hasan
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, AL
| | - Yuliang Zheng
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, AL
| | - James Davies
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ahmed Zaky
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
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Lau CP, Lee KLF, Tse HF. Inappropriate rate response in a leadless pacemaker due to automatic rate profile optimization. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:141-144. [PMID: 34714943 DOI: 10.1111/pace.14393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/20/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
A three-axis accelerometer sensor is incorporated in a leadless pacemaker (MicraTM , MedtronicInc ) for rate adaptation. Three sensor setpoints at lower rate (LR), activity of daily living rate (ADLR), and upper rate (UR) are used to convert detected acceleration to a desired rate response. We describe inappropriate rate acceleration at rest and during chest physiotherapy in a sedentary elderly patient with leadless pacemaker. The underlying mechanism and various programming options are discussed.
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Affiliation(s)
- Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kathy Lai-Fun Lee
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.,Shenzhen Institute of Research and Innovation, University of Hong Kong, Shenzhen, China
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