Key result
Tailoring Micra AV sensing parameters resolves position-dependent AV dyssynchrony and nocturnal palpitations.
Why the study?
Micra AV leadless pacemakers aim to maintain AV synchrony across body positions, but position-dependent AV dyssynchrony can occur and is not well characterized.
Case Report (n=1)
Position-dependent signal variations in Micra AV pacemakers can cause hidden AV dyssynchrony, which can be diagnosed and corrected using rate histogram analysis and manual atrial mechanical testing.
Answers are grounded in this paper and cite their sources.
May prompt histogram review for oversensing in symptomatic Micra AV; case evidence leaves optimal programming strategies open.
Micra AV leadless pacemakers aim to maintain atrioventricular (AV) synchrony across various body positions. This report describes a case of position-dependent AV dyssynchrony in an 81-year-old man with nocturnal palpitations despite having normal routine evaluations. Rate histogram analysis revealed an unusual distribution pattern, and manual atrial mechanical (MAM) testing demonstrated an increased A3 signal amplitude in the left lateral position, which resulted in oversensing. Adjusting the A3 threshold and window end settings resolved the symptoms and normalized the rate histogram. This case highlights the importance of position-dependent signal variations and rate histogram analyses in patients with a Micra AV.
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A 2025 study conducted a case report in Position-dependent atrioventricular dyssynchrony (n=1). Adjustment of A3 threshold and window end settings was evaluated on Resolution of symptoms and normalization of rate histogram. Adjusting the A3 threshold and window end settings in a Micra AV pacemaker resolved position-dependent atrioventricular dyssynchrony and nocturnal palpitations.
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