Aveir DR leadless pacemaker programming optimization for sinus node dysfunction patient: AAI+VVI mode initial experience in Poland

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Sinus node dysfunction (n=1). Intervention: AAI + VVI mode programming (Aveir DR leadless pacemaker) vs. DDDR mode programming. Primary outcome: Atrial pacing (Ap) percentage.

Aleksandra Winkler; Sebastian Metko; Zbigniew Orski; Marek Kiliszek; Dagmar Kowal

doi:10.33963/v.phj.111640

March 13, 2026Kardiologia PolskaOpen Access

Aveir DR leadless pacemaker programming optimization for sinus node dysfunction patient: AAI+VVI mode initial experience in Poland

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Key result

Reprogramming a leadless pacemaker to AAI+VVI mode extends battery life ~5 years by minimizing ventricular pacing.

n=1

Why the study?

Implant-to-implant communication in dual-chamber leadless pacemakers may require programming optimization steps depending on inter-device distance to ensure appropriate pacing and battery longevity.

Does reprogramming a dual-chamber leadless pacemaker to AAI + VVI mode improve symptoms and pacing parameters in a patient with sinus node dysfunction and poor implant-to-implant communication?

Key Points

To describe an individualized programming strategy for a dual-chamber leadless pacemaker in a patient with sinus node dysfunction experiencing suboptimal implant-to-implant communication.
Evaluated a 65-year-old female with sinus node dysfunction, history of infective endocarditis, and mechanical mitral valve replacement who received Abbott Aveir VR and Aveir AR leadless pacemakers.
Adjusted device programming from DDDR mode to independent AAI + VVI mode with implant-to-implant communication turned off (right atrium base rate: 60 bpm; right ventricle base rate: 50 bpm) after communication failure and pacemaker-mediated tachycardia occurred.
Assessed clinical symptoms, rate histograms, pacing percentages, and projected battery longevity at 1-month follow-up.
Switching to AAI + VVI mode increased atrial pacing from 54% to 99% and decreased ventricular pacing from 47% to <1%.
Intrinsic ventricular sensing was preserved at >99%, confirming effective spontaneous atrioventricular conduction without unnecessary ventricular pacing.
The reprogramming strategy resolved fatigue, dyspnea, and palpitations while extending projected device battery life by 4–5 years.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does reprogramming a dual-chamber leadless pacemaker to AAI + VVI mode improve symptoms and pacing parameters in a patient with sinus node dysfunction and poor implant-to-implant communication?

P

Population

1 65-year-old female with sinus node dysfunction, preserved AV conduction, type 1 diabetes, hypertension, and history of mechanical mitral valve replacement and pacemaker extraction due to infective endocarditis.

I

Intervention

Dual-chamber leadless pacemaker reprogrammed to AAI + VVI mode with implant-to-implant communication turned off (independent base rates RA: 60 bpm, RV: 50 bpm, active sensor in RA).

O

Outcome

Patient well-being, exercise tolerance, and pacing percentages (Ap, Vp, Vs) at 1-month follow-up.

Main Result

Absolute Event Rate: 99% vs 54%

In a patient with sinus node dysfunction and poor implant-to-implant communication, programming a dual-chamber leadless pacemaker to AAI + VVI mode resolved pacemaker syndrome and minimized unnecessary ventricular pacing.

Limitations

Single patient case report
Short follow-up duration of 1 month

Implication

Supports AAI+VVI mode in leadless PM patients with SND and poor i2i; hypothesis-generating for minimizing ventricular pacing and extending longevity.

Abstract

Leadless cardiac pacing integrates all components into a single intracardiac capsule under one cubic centimeter, attached directly to the endocardium [1].Patients diagnosed with sinus node dysfunction (SND) or atrioventricular (AV) block, who are at high risk of infections, post-lead extractions, valve repair or with limited vascular access, requiring AV synchrony, can be offered a dual-chamber (DC) leadless pacemaker (LPM) [1-3].At present DC LPM achieve AV synchrony through implant-to-implant (i2i) communication using low-energy electrical pulses, maintaining physiological AV delay comparable to traditional DDD pacing system [4].However, i2i communication, depending on atrial and ventricular LPMs distance, may require additional optimization steps to ensure appropriate pacing percentage and optimal battery longevity [4, 5].

Discussion

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Cite This Study

Winkler et al. (2026) conducted a case report in Sinus node dysfunction (n=1). AAI + VVI mode programming (Aveir DR leadless pacemaker) vs. DDDR mode programming was evaluated on Atrial pacing (Ap) percentage. Switching a leadless pacemaker to AAI+VVI mode in a sinus node dysfunction patient increased atrial pacing to 99%, reduced ventricular pacing to <1%, and extended battery life by 4-5 years.

synapsesocial.com/papers/69bb91c7496e729e6297f411 https://doi.org/10.33963/v.phj.111640

Topics

Left Bundle Branch Area Pacing

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Aveir DR leadless pacemaker programming optimization for sinus node dysfunction patient: AAI+VVI mode initial experience in Poland

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Aveir DR leadless pacemaker programming optimization for sinus node dysfunction patient: AAI+VVI mode initial experience in Poland

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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Topics

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