Optimizing Leadless Atrial Pacemaker Performance Through Strategic Reprogramming: A Quality Improvement Initiative.

BACKGROUND: Although implantation strategies for dual-chamber leadless pacemakers are well documented, long-term management, particularly concerning battery longevity, remains under observation. Atrial leadless pacemaker battery life is shorter than that of its ventricular counterpart in real-world observations without clear guidelines established for postimplantation programming. PROJECT RATIONALE: We undertook a quality improvement initiative in our outpatient device clinic to address battery longevity in leadless pacemakers via programming approaches targeting 6 optimization areas. A step-by-step algorithm was developed for device clinic staff. PROJECT SUMMARY: Twenty patients underwent algorithm-driven reprogramming by device clinic staff, with the average battery life increasing by 1.41 years to 5.48 years, a 33.7% improvement. Repeat interrogation at 90 days showed consistent longevity readings (5.4 years). TAKE-HOME MESSAGES: Dual-chamber leadless pacemakers require refined programming strategies. Implementing a structured algorithm in an outpatient device clinic enabled clinic staff to tailor settings for each patient, resulting in a substantial increase in battery life.