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Background <p>Very high acute pacing thresholds (VHPT) during AVEIR-AR atrial leadless pacemaker (ALP) implantation often prompt device repositioning, although excessive manipulation may increase procedural risk.</p> Objective <p>To evaluate the safety and early electrical performance of ALP release despite VHPT using a current-of-injury (COI)-guided strategy.</p> Methods <p>We retrospectively analyzed 28 consecutive patients who underwent AVEIR-AR ALP implantation at two centers in Japan and compared procedural safety and short-term electrical performance between patients with normal PTs (NPT &lt;5.5&#xa0;V at 0.4 ms) and those with VHPT (≥5.5&#xa0;V at 0.4 ms). In the VHPT group, ALP device release was permitted when pre-screw COI was adequate (≥1 mV).</p> Results <p>The mean age was 85±6 years, body weight was 54±8&#xa0;kg, and 11 patients were female. Single-site pre-mapping successful implantation was achieved in 36%, and repositioning was avoided in 89%, with no dislodgment, tamponade, or PT-related complications observed. Fourteen patients (50%) had VHPT, with comparable COI values between the VHPT and NPT groups (1.5±0.7 mV vs. 1.4±0.7 mV). In the VHPT group, PT improved from 5.9±0.2&#xa0;V at tether to 5.1±1.4&#xa0;V after release, 1.3±0.8&#xa0;V at discharge, and 0.8±0.6&#xa0;V at 1-month, with the initial between-group difference no longer evident. Sensitivity analyses using alternative cutoff values (≥5.0&#xa0;V and ≥6.0&#xa0;V) demonstrated consistent trends.</p> Conclusion <p>VHPT during ALP implantation improved after device release when adequate COI was present. A COI-guided release strategy may be feasible in selected cases and may help reduce mapping and screw attempts while enhancing procedural safety during ALP implantation.</p> Graphical abstract <p></p>

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Very high acute pacing thresholds during atrial leadless pacemaker implantation: Feasibility of a current-of-injury-guided release strategy

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Ryuki Chatani,
  • Taiki Yoshimura,
  • Kenta Yoshida,
  • Atsushi Sakata,
  • Mitsuru Yoshino,
  • Mitsuru Abe,
  • Shintaro Yamagami,
  • Toshihiro Tamura,
  • Hiroshi Tasaka

摘要

Background

Very high acute pacing thresholds (VHPT) during AVEIR-AR atrial leadless pacemaker (ALP) implantation often prompt device repositioning, although excessive manipulation may increase procedural risk.

Objective

To evaluate the safety and early electrical performance of ALP release despite VHPT using a current-of-injury (COI)-guided strategy.

Methods

We retrospectively analyzed 28 consecutive patients who underwent AVEIR-AR ALP implantation at two centers in Japan and compared procedural safety and short-term electrical performance between patients with normal PTs (NPT <5.5 V at 0.4 ms) and those with VHPT (≥5.5 V at 0.4 ms). In the VHPT group, ALP device release was permitted when pre-screw COI was adequate (≥1 mV).

Results

The mean age was 85±6 years, body weight was 54±8 kg, and 11 patients were female. Single-site pre-mapping successful implantation was achieved in 36%, and repositioning was avoided in 89%, with no dislodgment, tamponade, or PT-related complications observed. Fourteen patients (50%) had VHPT, with comparable COI values between the VHPT and NPT groups (1.5±0.7 mV vs. 1.4±0.7 mV). In the VHPT group, PT improved from 5.9±0.2 V at tether to 5.1±1.4 V after release, 1.3±0.8 V at discharge, and 0.8±0.6 V at 1-month, with the initial between-group difference no longer evident. Sensitivity analyses using alternative cutoff values (≥5.0 V and ≥6.0 V) demonstrated consistent trends.

Conclusion

VHPT during ALP implantation improved after device release when adequate COI was present. A COI-guided release strategy may be feasible in selected cases and may help reduce mapping and screw attempts while enhancing procedural safety during ALP implantation.

Graphical abstract