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Atrioventricular Synchronous Pacing Using a Leadless Ventricular Pacemaker: single centre experience
Session:
CO 11- Síncope
Speaker:
Pedro M. Lopes
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro M. Lopes; Diogo Cavaco; João Carmo; Pedro Carmo; Francisco m. Costa; Pedro Galvão Santos; Francisco b. Morgado; Sérgio Fartouce; Isabel Santos; Gustavo r. Rodrigues; Daniel n. Matos; Miguel Mendes; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">Background:</span></span></span></strong><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black"> </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">Despite many advantages, leadless pacemakers are currently only capable of single-chamber ventricular pacing.</span></span></span> <span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">More recently it was developed a new software to </span></span></span><span style="font-size:14.0pt">detect atrial contraction using a 3-axis accelerometer enabling AV synchronous pacing. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:14.0pt">Objectives:</span></strong><span style="font-size:14.0pt"> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:14.0pt">To evaluate the </span><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">feasibility of AV synchronous pacing in leadless pacemaker. </span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:14.0pt">Methods:</span></strong><span style="font-size:14.0pt"> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:14.0pt">This is a prospective single centre registry enrolling 11 consecutive patients with AV block referred to leadless pacemaker Micra <sup>TM</sup> with </span><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">AV synchronous algorithm (VDD). Baseline, procedural and follow-up data were collected. </span></span></span><span style="font-size:14.0pt"><span style="color:#2e2e2e">The last segment of cardiac activity in </span></span><span style="font-size:14.0pt">accelerometer <span style="color:#2e2e2e">signal (A4</span>) which corresponds to atrial contraction was measured in amplitude<span style="background-color:white"><span style="color:black">. Atrioventricular synchrony (AVS) was measured during 30 minutes of rest (Holter monitor) in patients with complete or high-degree AV block and was defined as a P wave visible on surface ECG followed by a ventricular event <300 ms.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">Results:</span></span></span></strong><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black"> </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">The mean age was 78 </span></span></span><span style="font-size:14.0pt"><span style="background-color:white"><span style="font-family:Symbol"><span style="color:black">±</span></span></span></span><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black"> 10 years and 73% were male. Complete or high-degree AV block was present in 5 patients, whereas 6 patients had predominantly intrinsic conduction. The mean pacing threshold during implantation was 0.71±0.34 V @ 0.24 ms. No major complications were reported. The mean follow up was 118±76 days. The mean pacing threshold during follow-up was 0.84±0.63 V @ 0.24 ms. The mean A4 amplitude was 1.7±1.9 m/s. The average AM-VP measured in office was 74% in patients with complete or high-degree AV block. After programming, the average AVS in complete or high-degree AV block measured with Holter monitor was 93%. </span></span></span><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:#222222">No patient showed sinus disease.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">Conclusions:</span></span></span></strong><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black"> </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:14.0pt"><span style="background-color:white"><span style="color:black">Leadless pacemaker with accelerometer-based atrial sensing is feasible and had a high AVS, similar to conventional VDD pacemakers with the advantages of leadless pacing.</span></span></span></span></span></p>
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