Japanese reimbursement approval for Micra AV TPS

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Medtronic has received approval from Japan’s Ministry of Health, Labor and Welfare for the sale and reimbursement of the Micra AV Transcatheter Pacing System (TPS), and the company will launch the product this month.

This approval expands the number of patients in Japan who are eligible to receive the Micra TPS, the world’s smallest pacemaker. The Micra AV is indicated for the treatment of patients with AV block, a condition in which the electrical signals between the chambers of the heart (the atria and the ventricle) are impaired. The Micra TPS is the first-ever leadless pacemaker; its first version (the Micra VR) was approved in Japan in 2017 for patients who only require single-chamber pacing.

“Pacemakers have made significant progress over their approximately 60-year history, including miniaturisation, improvements in pacing technology, MRI compatibility, and remote monitoring,” explained Kyoko Soejima, professor of cardiovascular internal medicine at Kyorin University Hospital, Tokyo, Japan, and a member of the Micra TPS Global Clinical Trial steering committee. “The first Micra system transformed the concept of pacemakers by eliminating surgical pockets and leads, and Micra AV promises to deliver the benefits of leadless pacing to a larger number of patients because ventricular pacing can be performed synchronously with the atrium.”

Historically, patients with AV block have been treated with traditional dual-chamber pacemakers which are implanted in the upper chest, under the skin below the collar bone, and connected to the heart using leads. Identical in size and shape to the original Micra TPS, Micra AV has several additional algorithms which detect cardiac movement, allowing the device to adjust pacing in the ventricle to coordinate with the atrium, providing “AV synchronous” pacing therapy to patients with AV block.

The Micra AV approval is based on data from the MARVEL 2 (Micra Atrial Tracking Using A Ventricular accELerometer) study, which evaluated the safety and effectiveness of accelerometer-based atrial sensing algorithms. The study evaluated the ability of the Micra’s internal sensor to monitor and detect atrial contractions and enable coordinated pacing between the atrium and ventricle, thereby providing AV synchrony.

“Since introducing the first battery-powered external pacemaker in 1957 to the innovative Micra leadless pacemaker portfolio, Medtronic continues to pioneer pacing innovations for physicians and their patients,” said Rob Kowal, chief medical officer of the Cardiac Rhythm Management business, which is part of the Cardiovascular Portfolio at Medtronic.


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