Rethinking Pacing Strategy in Sinus Node Dysfunction: Avoiding Transvenous Leads Matters
Abbott Cardiac Rythm Management | April 25, 2026
Current clinical guidelines from both the Heart Rhythm Society (HRS) and the European Society of Cardiology (ESC) recommend dual‑chamber pacing as the standard approach for most patients with sinus node dysfunction (SND), largely due to concerns regarding progression to atrioventricular (AV) block and the desire to preserve long‑term AV synchrony. 1,2 At the same time, the guidelines explicitly recognize single‑chamber atrial pacing (AAI) as an appropriate option in selected patients—particularly when there is a clinical reason to avoid additional leads or hardware.
Historically, the reasons to avoid leads have included limited venous access, high infection risk, or a desire to minimize procedural complexity. New real‑world evidence with leadless atrial pacing suggests that hardware avoidance itself may be a compelling therapeutic objective in appropriately selected SND patients.
In a large Coverage with Evidence Development (CED) analysis comparing AVEIR™ AR Atrial Leadless Pacemakers (LP) (n=428) with transvenous pacemakers (TVP) (n=39,881), atrial leadless pacing was associated with significantly fewer complications at 12 months.
Compared with dual-chamber TVPs, AVEIR AR Atrial LP significantly reduced
Overall
complications by 60%
(3.6% vs. 8.5%, p<0.01, adjusted)
Device-related complications by 50%
(3.5% vs. 7.4%, p<0.01, adjusted)
Device-related reinterventions by 60%
(1.8% vs. 4.5%, p=0.01, adjusted)
Procedural data3 and acute complications (within 30 days post implant) presented at HRS 2026 further support this safety profile. In a separate cohort comparing AVEIR AR Atrial LP (n=31) with dual‑chamber TVPs (n=93), no acute complications were observed in the AVEIR AR Atrial LP group. In contrast, 11.8% of patients undergoing TVP implantation experienced early complications, including lead dislodgement, pneumothorax, hematoma, and venous thrombosis (p<0.05) – events directly attributed to leads and pockets rather than atrial pacing itself.
Collectively, the data suggest that in patients with sinus node dysfunction and preserved AV conduction, leadless atrial pacing may represent a safe alternative to transvenous pacing. While dual‑chamber pacing remains appropriate for many patients, an atrial‑only leadless strategy may be reasonable when minimizing hardware‑related risk is a priority.
Rather than defaulting to dual‑chamber transvenous systems, therapy can reasonably begin with atrial-only leadless pacing, with escalation reserved for disease progression.
AVEIR AR Atrial LPs provide the flexibility to treat the condition present today while preserving the ability to upgrade to dual-chamber leadless pacing (AVEIR™ DR Dual Chamber LP System) should AV block develop, aligning pacing intensity with disease evolution rather than defaulting to maximal hardware upfront.
™ Indicates a trademark of the Abbott group of companies.
References:
1. Glikson, M., Nielsen, J. C., Kronborg, M. B., et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology with the special contribution of the European Heart Rhythm Association. EP Europace, 24(1), 71-164.
2. Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 74(7), e51-e156.
3. Hadadi et al. Reduced Complications with Leadless Atrial vs. Transvenous Dual-Chamber Pacemaker Implants. Presented at Heart Rhythm Conference 2026. [Data taken from final presentation].
