Real-life ambulatory performance of leadless AV synchronous pacemakers - are all questions answered?

The latest generation of leadless pacemakers is able to provide atrio-ventricular synchrony (AVS). The performance of these devices regarding ambulant AVS is still under debate. In an analysis by Garweg and co-authors, the AM-VP device counter was considered a reliable marker for true AVS and outpatient AVS in a large cohort was estimated to be ~75%. This editorial critically reflects the findings of Garweg et al. In general, evidence is increasing that leadless pacemakers with mechanical sensing provide an adequate degree of AVS in the outpatient setting. Device counters may indeed help to better understand specific programming-related challenges, but important questions regarding their diagnostic accuracy remain. This article is protected by copyright. All rights reserved.