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Key Teaching Points  • Current pacing guidelines recognize VDD pacing systems as an alternative to DDD pacemakers among patients with high-degree atrioventricular (AV) block. • The Micra Atrial TRacking Using a Ventricular AccELerometer (MARVEL) study has recently shown that an AV synchronous pacing mode is feasible using a single-chamber ventricular leadless pacemaker. • We present a first-in-human description of an episode of paroxysmal atrial fibrillation in an “AV synchronous ventricular leadless pacemaker.”

heartrhythm case reports

Response to atrial arrhythmias in an atrioventricular synchronous ventricular leadless pacemaker: A case report in a paroxysmal atrial fibrillation patient