Key result
Deactivating Aveir temperature-based rate response resolves rewarming-induced rapid pacing at ~130 beats/min during bypass weaning.
Why the study?
Leadless pacemaker use has grown with some devices now incorporating temperature-based sensors rather than motion-based sensors, creating susceptibility to unexpected rewarming-induced rapid pacing during cardiopulmonary bypass in cardiac surgery.
Case Report (n=1)
No
Patients with an Aveir leadless pacemaker undergoing cardiac surgery with cardiopulmonary bypass should have the temperature-based rate response feature disabled preoperatively to prevent rewarming-induced rapid ventricular pacing and hemodynamic instability.
Answers are grounded in this paper and cite their sources.
Temperature rate response deactivation resolved rewarming-induced pacing; this case leaves open whether preoperative adjustment prevents instability in Aveir devices.
BACKGROUND: Leadless pacemaker use has grown with some now including temperature-based sensors rather than motion-based sensors. We present a case of unexpected rewarming-induced rapid pacing during cardiopulmonary bypass in a patient with the Aveir leadless pacemaker. CASE SUMMARY: We present a case of a patient with a leadless pacemaker undergoing cardiac surgery and suffering from rapid ventricular pacing when weaning from bypass treated by applying a magnet to stop rapid pacing with device interrogation conducted intraoperatively. The rate response feature was disabled with the patient weaned from bypass. DISCUSSION: Traditional pacemakers use rate response features whereas the Aveir leadless pacemaker uses a temperature-based response feature. For this reason, the device is susceptible to inappropriate pacing when patients undergo rewarming during cardiac surgery resulting in possible hemodynamic compromise. TAKE-HOME MESSAGE: Patients undergoing cardiac surgery with leadless pacemakers in place should have a careful preoperative evaluation with the rate response feature turned off before surgery if indicated.
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Gokul et al. (2026) conducted a case report in Intraoperative tachycardia during cardiopulmonary bypass rewarming in a patient with an Aveir leadless pacemaker (n=1). Intraoperative magnet application and deactivation of the Aveir leadless pacemaker temperature-based rate response feature was evaluated on Resolution of rapid ventricular pacing and weaning from cardiopulmonary bypass. Deactivating the Aveir leadless pacemaker temperature-based rate response feature immediately resolved rewarming-induced rapid pacing at 130 beats/min and enabled weaning from cardiopulmonary bypass.
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