Multicenter study on electrical performance and predictive indicators in aveir VR pacemaker recipients.

BACKGROUND: There is limited evidence regarding the Aveir VR leadless pacemaker in mainland China, and the intraoperative electrical indicators linked to a favorable chronic pacing capture threshold (PCT) are not clearly defined. METHODS: This retrospective study across multiple centers involved 100 patients from Sichuan Province who received Aveir VR implants between January 2023 and December 2025, with electrical data available for evaluation at least one month after implantation.Chronic PCT was considered excellent if it was ≤ 0.5 V at 0.4 ms during the first device check after at least one month.Intraoperative predictors were identified using multivariable logistic regression.Receiver Operating Characteristic(ROC) analysis with bootstrap validation (500 replicates) was used to assess discrimination, and generalized additive models (GAMs) were employed to evaluate nonlinearity. RESULTS: In 100 patients, the device implantation was successful with no significant complications, and 66 of them (66%) achieved excellent chronic PCT after a median follow-up period of 134 days. PCT improved from 0.76 ± 0.49 V at end of procedure to 0.63 ± 0.24 V at follow-up.Tether-phase R-wave sensing was independently associated with excellent chronic PCT (adjusted OR 1.27, 95% CI 1.06-1.51; P = 0.009). Tether-phase sensing showed modest discrimination (bias-corrected AUC 0.64, 95% CI 0.52-0.75). The 5.85 mV cutoff yielded sensitivity 68.3%, specificity 68.8%, PPV 80.4%, and NPV 53.7%. GAM indicated a nonlinear association (P for nonlinearity = 0.009). CONCLUSIONS: In this cohort from mainland China, the implantation of Aveir VR was both feasible and safe, demonstrating stable short-term electrical performance. The sensing amplitude of the R-wave in the tether phase appears to be an additional intraoperative marker connected to excellent chronic PCT. Before recommending a specific cutoff for regular use, standardized long-term follow-up and external validation are necessary. Among 100 Aveir VR recipients in Chinese mainland, tether-phaseR-wave sensing was associated with excellent chronic PCT and demonstrated modestdiscriminative ability, indicating its potential role as a complementary intraoperativemarke.