A Modular Approach for Leadless Pacing

INTRODUCTION: The AVEIR leadless pacemaker (LP) is a novel device that can function as a single atrial/ventricular or dual-chamber pacemaker. The introduction of single-chamber atrial LP has allowed electrophysiologists to treat patients with sinus node dysfunction with this device instead of implanting a dual-chamber transvenous pacemaker. METHODS: We retrospectively identified all patients who underwent AVEIR LPs' implantation at Emory Healthcare between 2022 and 2025. Baseline characteristics, indications for pacing, and procedure outcomes were retrieved from electronic medical records. The device's electrical characteristics were reported from routine interrogations done at our device clinic. RESULTS: Between 2022 and 2025, 89 patients underwent implantation of 37 single-chamber atrial AVEIR, 34 single-chamber ventricular AVEIR, and 18 dual-chamber devices. Patients were followed for a median duration of 4.7 months [2;9]. The rate of major complications was 3.4% and minor complications 1.1%. Two patients with ventricular LP required upgrade to cardiac resynchronization therapy-defibrillator (CRT-D) due to pacing-induced cardiomyopathy (2.3%). One patient (2.7%) with a standalone atrial LP developed atrial fibrillation with slow ventricular response requiring the addition of a ventricular LP 10 months postimplantation. CONCLUSION: In our center, we adopted a modular pacing approach for leadless pacing. This strategy focuses on minimizing the amount of hardware in the heart. This reduces complications such as perforation and dislodgment while optimizing battery longevity, which is affected by i2i communication.