Pacemaker Replacement Decision Report

Patient Summary

• Age: 71 years old
• Current device: Unicameral leadless pacemaker (likely Aveir VR or Micra VR)
• Battery status: Nearing end of life
• General health: Healthy, presumed normal organ function
• Rhythm: Presumed sinus rhythm with possible AV conduction
• Goals: Safety, long-term pacing strategy, physiological pacing

Replacement Options

1. Bicameral Leadless Pacemaker (e.g., Abbott Aveir DR)

• Provides dual-chamber pacing with AV synchrony while remaining leadless
• Avoids subclavian access and pocket-related complications
• Compatible with Aveir VR platform for easier upgrade and retrieval
• Minimally invasive with no transvenous leads

• Requires extraction of existing leadless device
• Limited long-term clinical data
• More complex sensing/monitoring setup
• Not compatible with conduction system pacing (CSP)

2. Transvenous Conduction System Pacing (CSP)

• Preserves native conduction (most physiological pacing)
• Endorsed in guidelines for AV block and pacing-induced cardiomyopathy prevention
• Allows long-term pacing adaptability and broader device options

• Requires venous access and permanent leads
• Potential risk of infection and lead complications
• Involves creation of a subcutaneous pocket
• Technically demanding procedure (depends on implanter expertise)

Decision Pathway

Clinical Recommendation

For a healthy 71-year-old patient with a unicameral Aveir VR nearing battery depletion:

• If the patient has intact atrial rhythm and desires AV synchrony without leads: recommend replacing the device with the Abbott Aveir DR after retrieval of the Aveir VR.
• If physiological pacing and hemodynamic performance are top priorities, especially in the presence of AV block or high pacing burden: recommend a transvenous CSP system (His or LBBP), if the implanting center has strong CSP expertise.
• Avoid abandonment of the existing device unless retrieval is contraindicated.

Shared decision-making with the patient and EP team is advised.