Abstract
Leadless pacemakers (LLPMs) have become a major breakthrough in the management of bradyarrhythmia as an attractive alternative to the standard transvenous pacemakers (TV-PMs). Recently, the introduction of a second-generation LLPMs (Micra AV-MC1AVR1) has expanded pacing modes to obtain atrioventricular (AV) synchronous pacing, providing an interesting alternative in the actual scenario of leadless pacing. Nevertheless, actual reports have highlighted some concerns regarding those devices. In this review, we sought to provide an overview of this technology based on its approval studies and major reports.
Highlights
Since its inception, transvenous pacemaker (TV-PM) therapy evolved over time, providing significant benefits in terms of quality of life, thereby reducing mortality in highrisk patients with second-degree type II or third-degree atrioventricular block (AVB) [1]
First-generation leadless pacemakers (LLPMs) are only able to pace the ventricle, which largely limit their use to patients with atrial fibrillation (AF) with slow ventricular conduction and those considered to be at high-risk of TV-PMs related complications
The Micra-AV was initially implanted as a bridge therapy after biventricular pacemaker lead extraction, until a new transvenous biventricular system could be reimplanted after a complete resolution of the infectious process
Summary
Transvenous pacemaker (TV-PM) therapy evolved over time, providing significant benefits in terms of quality of life, thereby reducing mortality in highrisk patients with second-degree type II or third-degree atrioventricular block (AVB) [1]. Despite these positive effects, TV-PMs are still associated with a significant rate of combined short- and long-term system failure of up to 20% at 5 years. Pacing modes that preserve atrioventricular synchrony (AVS) are recommended as a class I indication in patients who have high-degree AV block and sinus rhythm requiring permanent pacing, with dual-chamber pacemakers as the first choice and single-lead VDD pacing systems as a valid alternative [7]. The only LLPM on the market, able to provide atrioventricular synchrony (VDD pacing mode), is the Micra AVMC1AVR1 Transcatheter Pacing System (Medtronic, Inc., Minneapolis, MN, USA)
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