The role of conventional and speckle tracking echocardiography in the evaluation of leadless endocardial pacing with Micra-AV

Abstract Aims Micra-AV pacing system is a leadless pacemaker (LP) implanted in the right ventricle which can provide atrio-ventricular (AV) synchronous pacing. Echocardiographic data assessing left ventricle contractility 24–48 h after Micra AV implantation are lacking. To evaluate via conventional echocardiography and speckle-tracking echocardiography (STE), which was the best pacing modality (VVI vs. VDD) able to ensure the most efficient hemodynamic performance assessed by left ventricle ejection fraction (LF-EF) and global longitudinal strain (GLS). Methods and results We studied nine patients with high degree AV-block, enrolled in our Institution in a range of time of 5 months. All patients had first degree AV block (PQ interval between 160 and 340 ms). They were considered suitable candidates for MICRA-AV implantation according to current guidelines. Both LF-EF and GLS were performed 24–48 h after device implantation by two experienced echocardiographic physicians. The mean age of the population was 79 ± 8 years (8 were male, 89%). Risk factors more represented were hypertension and dyslipidaemia. The maximum PQ interval was 256 ± 51 ms. VDD pacing modality allows better LV-EF values than those obtained with a VVI stimulation (with a difference that was statistically significant difference, P-value = 0.008). Similarly, we obtained better GLS values during VDD pacing as respect to VVI (P-value = 0.008). Conclusions Left ventricle ejection fraction and LV-GLS improve early after leadless MICRA-AV implantation during VDD as compared to VVI pacing modality.