Mapping the future: Predictive value of commanded electrogram parameters for the pacing performance in active-fixation leadless pacemakers.

Background: In Aveir VR (Abbott Medical) leadless pacemaker implantation, commanded electrograms (cEGMs) are used before and after fixation to evaluate the suitability of the fixation site. However, no clinical studies have examined its predictive value or optimal cutoff values. Objective: The purpose of this study was to investigate the association between the midterm pacing capture threshold (PCT) and cEGM parameters after Aveir VR implantation procedures. Methods: We retrospectively analyzed consecutive 74 patients who underwent Aveir VR implantation at Sendai Kosei Hospital with analyzable cEGM data. cEGM parameters, including QRS amplitude, QRS duration, and current of injury (COI), were measured during the premapping and tether modes. The highest PCT recorded within 1 year of implantation was used as the primary outcome. An elevated PCT was defined as >1.5 V/0.4 ms. Correlations were analyzed, and receiver operating characteristic analyses identified optimal cutoff values for the COI and QRS amplitude. Results: Both the COI and the QRS amplitude showed weak but significant correlations with the PCT. The area under the curve for the COI was 0.715 (premapping) and 0.668 (tether), with cutoff values of >2.0 mV. The COI was associated with a high PCT (premapping mode: odds ratio [OR] 7.5, 95% confidence interval [CI] 1.6-44.6; tether mode: OR 4.8, 95% CI 1.1-21.4). The QRS amplitude had area under the curves of 0.771 in the premapping mode and 0.840 in the tether mode, with cutoff values of >5.0 mV (OR 12.0; 95% CI 1.4-101.7) and >4.0 mV (OR 15.5; 95% CI 2.8-83.9), respectively. Conclusion: Even before fixation, the COI and QRS amplitude are useful predictors of the midterm PCT after Aveir VR implantation. Combined assessment may enhance fixation strategies.