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Mode Optimization in Leadless Pacing: Unlocking Battery Longevity and Tailored Therapy

Abbott Cardiac Rhythm Management | July 8, 2025

A central theme at HRS 2025 was the growing clinical emphasis on smart programming in leadless pacing—particularly for patients with Sinus Node Dysfunction (SND). Across multiple sessions and symposia, experts highlighted how intelligent mode selection and reprogramming not only extend battery longevity but also enable a more personalized approach to bradycardia management.

Dr. Rahul Doshi (HonorHealth) presented compelling data demonstrating that reprogramming AVEIR™ DR Dual Chamber Leadless Pacemaker (LP) System from traditional DDD mode to AAI(R)+VVI significantly enhances device longevity. At HonorHealth, switching patients to AAI mode extended battery life to 10.1 years—a remarkable 90.6% increase—far surpassing gains achieved through isolated parameter adjustments such as voltage, pulse width, i2i^™, and Lower Rate Limit (LRL).

Beyond longevity, programming optimization supports a broader shift toward individualized, clinically driven pacing strategies. During the Abbott-sponsored lunch symposium, Dr. Ip explored the evolution of leadless pacing in managing SND, focusing on the importance of preserving atrioventricular (AV) synchrony to prevent pacemaker syndrome—a known risk of VVI(R) pacing. He emphasized the long-term risks associated with ventricular-only pacing, such as exertional intolerance and atrial arrhythmias, and advocated for shared decision-making when selecting between AAI(R), AAI(R)+VVI, or dual chamber DDD configurations. Through two detailed case studies—including the first AVEIR DR Dual Chamber LP System implant with a projected longevity exceeding 10 years—Dr. Ip demonstrated how modular, programmable pacing systems can improve patient outcomes, reduce complications, and enhance quality of life.

Echoing this perspective during the symposium, Dr. Rajesh Banker (Hoag) emphasized the value of tailored pacing therapy based on individual patient profiles. He described how the modular design of the AVEIR™ DR LP System, with its atrial (AR) and ventricular (VR) components, allows clinicians to adjust pacing modes according to clinical parameters such as AV conduction, structural heart disease, and symptom burden. By leveraging flexible configurations like AAI(R), AAI(R)+VVI, or DDD, physicians can deliver more targeted bradycardia therapy while minimizing unnecessary ventricular pacing and preserving AV synchrony. Dr. Banker illustrated these principles through practical algorithms and real-world case studies, reinforcing the role of adaptable pacing in modern electrophysiology.

Taken together, the insights presented at HRS 2025 mark a clear shift from one-size-fits-all pacing toward a modular, patient-centric approach. Through smart programming and mode optimization, clinicians can now achieve longer device longevity, more physiologic pacing, and individualized care—laying the foundation for a new era in leadless cardiac rhythm management.