Heterologous atrial-only leadless rescue using an Abbott Aveir atrial LP reduced ventricular pacing from 100% to 0.1% and resolved symptoms of pacemaker syndrome without device extraction.
Case Report (n=1)
Does heterologous atrial-only leadless rescue improve symptoms and reduce ventricular pacing in a patient with pacemaker syndrome and preserved antegrade conduction?
Heterologous atrial-only leadless rescue can restore atrioventricular synchrony and resolve pacemaker syndrome in select patients with preserved antegrade conduction without requiring device extraction.
Absolute Event Rate: 0.1% vs 100%
BACKGROUND: The Medtronic Micra AV leadless pacemaker (LP) can preserve atrioventricular synchrony via accelerometer-based mechanical sensing; however, tracking limitations may result in pacemaker syndrome. CASE SUMMARY: A 61-year-old woman underwent Micra AV LP implantation for symptomatic postoperative junctional bradycardia after redo aortic root and bioprosthetic aortic valve replacement for prosthetic valve endocarditis, which was complicated by postoperative stroke and recurrent infections. She developed persistent exertional dyspnea despite recovery of left ventricular function and normal prosthetic valve function. Interrogation showed 100% ventricular pacing; electrocardiography showed retrograde P waves; and exercise testing identified preserved antegrade conduction. An Abbott Aveir atrial LP was implanted to restore atrioventricular synchrony, whereas the prior Micra LP was retained as low-rate ventricular backup. DISCUSSION: Atrial-only leadless rescue reduced ventricular pacing to 0.1% and resolved symptoms without transvenous upgrade or prior device extraction. TAKE-HOME MESSAGE: Provocative testing can identify select patients in whom heterologous atrial-only leadless rescue may restore synchrony without extraction.
Sojitra et al. (Wed,) conducted a case report in Pacemaker syndrome (n=1). Abbott Aveir atrial leadless pacemaker implantation was evaluated on Ventricular pacing percentage and symptom resolution. Heterologous atrial-only leadless rescue using an Abbott Aveir atrial LP reduced ventricular pacing from 100% to 0.1% and resolved symptoms of pacemaker syndrome without device extraction.