Atrioventricular Synchrony Algorithm Modeling of a Leadless Pacemaker Family: A Virtual Patient Analysis

• Published in: Cardiovascular engineering and technology Vol. 16; no. 4; pp. 410 - 422
• Main Authors: Leal, Miguel A., Sheldon, Todd, Escalante, Keelia, Holm, Mikayle, Galarneau, Michelle, Stromberg, Kurt, Piccini, Jonathan P.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2025; Springer Nature B.V
• Subjects: Accelerometers; Accelerometry; Algorithms; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - therapy; Atrioventricular Node - physiopathology; Biomedical and Life Sciences; Biomedical Engineering and Bioengineering; Biomedical Engineering/Biotechnology; Biomedicine; Cardiac Pacing, Artificial; Cardiology; Equipment Design; Heart Rate; Humans; Models, Cardiovascular; Monte Carlo Method; Monte Carlo simulation; Original; Original Article; Pacemaker, Artificial; Pacemakers; Patient-Specific Modeling; Patients; Programming; Time Factors; Atrioventricular synchrony; Algorithm; Leadless pacemaker; Modeling; Virtual patient
• ISSN: 1869-408X; 1869-4098; 1869-4098
• DOI: 10.1007/s13239-025-00783-0

Purpose To assess the impact of enhancements to the Atrioventricular Synchrony (AVS) algorithms of a next generation Micra leadless pacemaker (Micra AV2). Methods Accelerometer data were extracted from the AccelAV clinical study and were used to create virtual patients. A series of Monte Carlo simulations were run for each virtual patient to compare an enhanced Atrial Sensing Setup algorithm and Auto + A3 Threshold algorithm vs. original algorithms. A real-world survey was also conducted to observe clinical time savings from AVS programming burden reduction. Results The enhanced Atrial Sensing Setup in Micra AV2 devices demonstrated > 70% AVS in 27 of 30 (90%) patients while 13 of 30 (43%) Micra AV patients had > 70% AVS ( p  < 0.001) with no manual programming. The Micra AV2 Auto + A3 Threshold without additional manual programming demonstrated improved overall ambulatory AVS in the 80–100 bpm range (84.1%). Based upon survey results, the enhanced Atrial Sensing Setup algorithm accounted for an estimated reduction in median device check time of 13 min per patient. Conclusions Simulation-based analyses of the Micra AV2 leadless pacemaker projected significant improvements in automatic AVS at high sinus rates and an increase in the number of patients with > 70% AVS without clinician programming. Real-world survey results reported a reduction in device check time with the improvements. Significance: Improvements in the AVS algorithms in Micra AV2 allow for better automatic AVS at higher heart rates and reduced clinic utilization burden.