{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:28:32Z","timestamp":1788931712501,"version":"build-2803163510"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T00:00:00Z","timestamp":1709769600000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The second generation of transcatheter pacing systems, called Micra AV, can provide atrioventricular (AV) synchronous pacing via a new pacing algorithm relying on sensing mechanical atrial contraction. Several novel programming parameters were introduced to enable AV synchronous pacing, including an A3 window and A4 window as well as a conduction mode switch and an activity mode switch. In addition to several automated features, manual programming optimization of some of the novel parameters is key to improving AV synchrony. A solid knowledge of the features and their programming is essential for electrophysiologists implanting or following patients with Micra AV devices. Differences in programming optimization might partially explain the high variability of AV synchrony published in real-world data reports. This article reviews the key programming parameters of Micra AV. Subsequently, optimal programming recommendations for defined patient profiles are presented. Those were established by consensus within an expert panel comprised of 11 European electrophysiologists from high-volume Micra AV centres. The patient profiles were (1) high degree AV block and slow sinus rhythm; (2) high degree AV block and fast sinus rhythm; and (3) intermittent AV block. The panel recommended to evaluate the mechanical atrial activity on transthoracic echocardiography prior to implant. It was also agreed that Auto A3 Threshold and Tracking Check should be turned off in all patients, AV conduction mode switch should be turned off in all patients with high degree AV block, and the lower rate should be programmed to 50\u2005bpm with exceptions based on individual clinical assessment. Future studies will be useful to evaluate the strength of those recommendations to improve the AV synchrony.<\/jats:p>","DOI":"10.1093\/europace\/euae060","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T08:31:25Z","timestamp":1709800285000},"source":"Crossref","is-referenced-by-count":20,"title":["Strategies to improve atrioventricular synchrony in patients with a Micra AV leadless pacemaker"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2173-1035","authenticated-orcid":false,"given":"Christophe","family":"Garweg","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, University Hospitals Leuven , Herestraat 49 , 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4440-2947","authenticated-orcid":false,"given":"Alexander","family":"Breitenstein","sequence":"additional","affiliation":[{"name":"Center for Cardiac Arrhythmias and Cardiac Electrophysiology, Universit\u00e4tsSpital Z\u00fcrich , Zurich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7415-0787","authenticated-orcid":false,"given":"Nicolas","family":"Cl\u00e9menty","sequence":"additional","affiliation":[{"name":"Cardiology Department, Clinique du Millenaire , Montpellier , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9351-0760","authenticated-orcid":false,"given":"Carlo","family":"De Asmundis","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Center, University Hospital Brussels , Brussels , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2131-1110","authenticated-orcid":false,"given":"Saverio","family":"Iacopino","sequence":"additional","affiliation":[{"name":"Department of Arrhythmia and Electrophysiology, Maria Cecilia Hospital , Cotignola , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7157-7948","authenticated-orcid":false,"given":"Jens Brock","family":"Johansen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital , Odense , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sharman","sequence":"additional","affiliation":[{"name":"Cardiology Service, Northampton General Hospital NHS Trust , Cliftonville , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5442-4464","authenticated-orcid":false,"given":"Cathrin","family":"Theis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Robert-Bosch-Krankenhaus Stuttgart , Stuttgart , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8243-1271","authenticated-orcid":false,"given":"Xavier Vi\u00f1olas","family":"Prat","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sant Pau Hospital , Barcelona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Winter","sequence":"additional","affiliation":[{"name":"Cardiology and Rhythmology, Saint Vinzenz Hospital , Cologne , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7197-8415","authenticated-orcid":false,"given":"Tobias","family":"Reichlin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital\u2014University of Bern , Bern , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,7]]},"reference":[{"key":"2024032716161418100_euae060-B1","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/j.hrthm.2018.08.005","article-title":"Updated performance of the Micra transcatheter pacemaker in the real-world setting: a comparison to the investigational study and a transvenous historical control","volume":"15","author":"El-Chami","year":"2018","journal-title":"Heart Rhythm"},{"key":"2024032716161418100_euae060-B2","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1093\/eurheartj\/ehab767","article-title":"Leadless vs. transvenous single-chamber ventricular pacing in the Micra CED study: 2-year follow-up","volume":"43","author":"El-Chami","year":"2022","journal-title":"Eur Heart J"},{"key":"2024032716161418100_euae060-B3","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jacep.2019.10.017","article-title":"Atrioventricular synchronous pacing using a leadless ventricular pacemaker: results from the MARVEL 2 study","volume":"6","author":"Steinwender","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"key":"2024032716161418100_euae060-B4","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.hroo.2021.08.003","article-title":"Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: a single-center experience","volume":"2","author":"Arps","year":"2021","journal-title":"Heart Rhythm O2"},{"key":"2024032716161418100_euae060-B5","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1016\/j.hrthm.2022.08.007","article-title":"Optimizing atrial sensing parameters in leadless pacemakers: atrioventricular synchrony achievement in the real world","volume":"19","author":"Briongos-Figuero","year":"2022","journal-title":"Heart Rhythm"},{"key":"2024032716161418100_euae060-B6","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.hrthm.2022.08.033","article-title":"Ambulatory atrioventricular synchronous pacing over time using a leadless ventricular pacemaker: primary results from the AccelAV study","volume":"20","author":"Chinitz","year":"2023","journal-title":"Heart Rhythm"},{"key":"2024032716161418100_euae060-B7","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1111\/jce.15726","article-title":"Correlation between AV synchrony and device collected AM-VP sequence counter in atrioventricular synchronous leadless pacemakers: a real-world assessment","volume":"34","author":"Garweg","year":"2023","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2024032716161418100_euae060-B8","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.hrthm.2021.12.025","article-title":"Leadless atrioventricular synchronous pacing in an outpatient setting: early lessons learned on factors affecting atrioventricular synchrony","volume":"19","author":"Neugebauer","year":"2022","journal-title":"Heart Rhythm"},{"key":"2024032716161418100_euae060-B9","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur Heart J"},{"key":"2024032716161418100_euae060-B10","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1093\/europace\/euac066","article-title":"Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA\/HRS\/LAHRS\/APHRS","volume":"24","author":"Boersma","year":"2022","journal-title":"Europace"},{"key":"2024032716161418100_euae060-B11","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1016\/j.hrthm.2020.07.024","article-title":"Predictors of atrial mechanical sensing and atrioventricular synchrony with a leadless ventricular pacemaker: results from the MARVEL 2 Study","volume":"17","author":"Garweg","year":"2020","journal-title":"Heart Rhythm"},{"key":"2024032716161418100_euae060-B12","doi-asserted-by":"crossref","first-page":"2510","DOI":"10.1093\/eurheartj\/ehv214","article-title":"Early performance of a miniaturized leadless cardiac pacemaker: the Micra Transcatheter Pacing Study","volume":"36","author":"Ritter","year":"2015","journal-title":"Eur Heart J"},{"key":"2024032716161418100_euae060-B13","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1056\/NEJMoa1511643","article-title":"A leadless intracardiac transcatheter pacing system","volume":"374","author":"Reynolds","year":"2016","journal-title":"N Engl J Med"},{"key":"2024032716161418100_euae060-B14","author":"Medtronic, Inc"}],"container-title":["Europace"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/europace\/advance-article-pdf\/doi\/10.1093\/europace\/euae060\/56888464\/euae060.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/26\/3\/euae060\/57099293\/euae060.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/26\/3\/euae060\/57099293\/euae060.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T19:49:22Z","timestamp":1711568962000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/doi\/10.1093\/europace\/euae060\/7623632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,1]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euae060","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,3]]},"published":{"date-parts":[[2024,3,1]]},"article-number":"euae060"}}