{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:37:23Z","timestamp":1775803043926,"version":"3.50.1"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Eng Tech"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>To assess the impact of enhancements to the Atrioventricular Synchrony (AVS) algorithms of a next generation Micra leadless pacemaker (Micra AV2).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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\u2009+\u2009A3 Threshold algorithm vs. original algorithms. A real-world survey was also conducted to observe clinical time savings from AVS programming burden reduction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The enhanced Atrial Sensing Setup in Micra AV2 devices demonstrated\u2009&gt;\u200970% AVS in 27 of 30 (90%) patients while 13 of 30 (43%) Micra AV patients had\u2009&gt;\u200970% AVS (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) with no manual programming. The Micra AV2 Auto\u2009+\u2009A3 Threshold without additional manual programming demonstrated improved overall ambulatory AVS in the 80\u2013100\u00a0bpm 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>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\u2009&gt;\u200970% AVS without clinician programming. Real-world survey results reported a reduction in device check time with the improvements. <jats:italic>Significance:<\/jats:italic> Improvements in the AVS algorithms in Micra AV2 allow for better automatic AVS at higher heart rates and reduced clinic utilization\u00a0burden.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s13239-025-00783-0","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T12:05:23Z","timestamp":1748347523000},"page":"410-422","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Atrioventricular Synchrony Algorithm Modeling of a Leadless Pacemaker Family: A Virtual Patient Analysis"],"prefix":"10.1007","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4797-4617","authenticated-orcid":false,"given":"Miguel A.","family":"Leal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd","family":"Sheldon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keelia","family":"Escalante","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikayle","family":"Holm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Galarneau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kurt","family":"Stromberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan P.","family":"Piccini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"issue":"9","key":"783_CR1","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1016\/j.hrthm.2018.05.004","volume":"15","author":"L Chinitz","year":"2018","unstructured":"Chinitz, L., et al. Accelerometer-based atrioventricular synchronous pacing with a ventricular leadless pacemaker: Results from the Micra atrioventricular feasibility studies. Heart Rhythm. 15(9):1363\u20131371, 2018. https:\/\/doi.org\/10.1016\/j.hrthm.2018.05.004.","journal-title":"Heart Rhythm"},{"issue":"1","key":"783_CR2","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.hrthm.2022.08.033","volume":"20","author":"LA Chinitz","year":"2023","unstructured":"Chinitz, L. A., et al. Ambulatory atrioventricular synchronous pacing over time using a leadless ventricular pacemaker: Primary results from the AccelAV study. Heart Rhythm. 20(1):46\u201354, 2023. https:\/\/doi.org\/10.1016\/j.hrthm.2022.08.033.","journal-title":"Heart Rhythm"},{"issue":"1","key":"783_CR3","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.jacep.2019.10.017","volume":"6","author":"C Steinwender","year":"2020","unstructured":"Steinwender, C., et al. Atrioventricular synchronous pacing using a leadless ventricular pacemaker: Results from the MARVEL 2 study. JACC Clin Electrophysiol. 6(1):94\u2013106, 2020. https:\/\/doi.org\/10.1016\/j.jacep.2019.10.017.","journal-title":"JACC Clin Electrophysiol"},{"issue":"5","key":"783_CR4","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.hroo.2021.08.003","volume":"2","author":"K Arps","year":"2021","unstructured":"Arps, K., et al. Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience. Heart Rhythm O2. 2(5):455\u2013462, 2021. https:\/\/doi.org\/10.1016\/j.hroo.2021.08.003.","journal-title":"Heart Rhythm O2"},{"issue":"12","key":"783_CR5","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1016\/j.hrthm.2022.08.007","volume":"19","author":"S Briongos-Figuero","year":"2022","unstructured":"Briongos-Figuero, S., et al. Optimizing atrial sensing parameters in leadless pacemakers: Atrioventricular synchrony achievement in the real world. Heart Rhythm. 19(12):2011\u20132018, 2022. https:\/\/doi.org\/10.1016\/j.hrthm.2022.08.007.","journal-title":"Heart Rhythm"},{"issue":"5","key":"783_CR6","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/j.hrthm.2021.12.025","volume":"19","author":"F Neugebauer","year":"2022","unstructured":"Neugebauer, F., et al. Leadless atrioventricular synchronous pacing in an outpatient setting: Early lessons learned on factors affecting atrioventricular synchrony. Heart Rhythm. 19(5):748\u2013756, 2022. https:\/\/doi.org\/10.1016\/j.hrthm.2021.12.025.","journal-title":"Heart Rhythm"},{"issue":"3","key":"783_CR7","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1111\/j.1540-8167.2010.01918.x","volume":"22","author":"KJ Volosin","year":"2011","unstructured":"Volosin, K. J., D. V. Exner, M. S. Wathen, L. Sherfesee, A. P. Scinicariello, and J. M. Gillberg. Combining shock reduction strategies to enhance ICD therapy: A role for computer modeling. J. Cardiovasc. Electrophysiol. 22(3):280\u2013289, 2011. https:\/\/doi.org\/10.1111\/j.1540-8167.2010.01918.x.","journal-title":"J. Cardiovasc. Electrophysiol."}],"container-title":["Cardiovascular Engineering and Technology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13239-025-00783-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13239-025-00783-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13239-025-00783-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T06:44:58Z","timestamp":1755672298000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13239-025-00783-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":7,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["783"],"URL":"https:\/\/doi.org\/10.1007\/s13239-025-00783-0","relation":{},"ISSN":["1869-408X","1869-4098"],"issn-type":[{"value":"1869-408X","type":"print"},{"value":"1869-4098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]},"assertion":[{"value":"13 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"MAL: receives grants for clinical research from Medtronic and serves as a consultant to Medtronic and Sanofi; TS, KE, MH, MG, and KS: Employees and shareholders of Medtronic; JPP: supported by R01HL128595 from the National Heart, Lung, and Blood Institute, receives grants for clinical research from Abbott, American Heart Association, Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, and Philips, and serves as a consultant to Abbott, Abbvie, Ablacon, Altathera, ARCA Biopharma, Biotronik, Boston Scientific, Bristol Myers Squibb, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, Itamar, Pfizer, Sanofi, Philips, ResMed, and Up-to-Date.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}},{"value":"The AccelAV study protocol was approved by the local ethics committee at each institution.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"All patients in the AccelAV study provided written informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Publish"}}]}}