Atrial mechanical contraction and ambulatory atrioventricular synchrony: Predictors from the OPTIVALL study

Abstract Introduction The role that preprocedural factors have on atrioventricular synchrony (AVS) provided by leadless pacemakers requires investigation. Methods and Results We aimed to assess the correlation between mitral inflow echocardiographic parameters and p‐wave morphology with the accelerometer A4 signal amplitude. We also sought to identify clinical and echocardiographic predictors of optimal ambulatory AVS (≥85% of cardiac cycles). Forty‐three patients undergoing Micra AV implant from June 2020 to March 2023 were prospectively enrolled. Baseline echocardiogram and 12‐lead resting ECG were performed. Device follow‐up was scheduled at 24 h, 1, 3, and 6 months and yearly after the implant. Ambulatory AVS was studied with a 24 h Holter monitor performed at 3 months follow‐up in 35 patients who remained in VDD mode. A4 signal amplitude at 1 month correlated to peak A wave velocity ( r = .376; p = .024) at echocardiogram, but no relationship was found with peak A' wave velocity, E/A, or E'/A' ratio. P‐wave amplitude in lead I and aVF correlated to A4 signal amplitude at 1‐ and 3‐months follow‐up, respectively. Median AVS during 24 h of daily activities was 85.6 ± 7.6% and remained stable up to 100 bpm. Twenty‐three out of 35 patients (65.7%) reached optimal ambulatory AVS. There was no association between mitral inflow echocardiographic parameters and optimal AVS. Diabetes (OR: 0.05, 95% CI: 0.01−0.47; p = .009) and chronic obstructive pulmonary disease (COPD) (OR: 0.06, 95% CI: 0.01−0.63; p = .019) strongly predicted ambulatory AVS <85%. Conclusions Diabetes and COPD should be considered when selecting candidates for Micra AV. Measurements of pulsed wave Doppler mitral inflow do not systematically reflect the behavior of the A4 signal amplitude.