无导线心脏起搏器：中文患者教育版 制作：黄剑锋医生（Dr Ng Kim Fong） 用途与说明 本片为一般患者教育，并非个人医疗建议、操作培训或知情同意书的替代品。 起搏器的选择取决于心律、心脏功能、预计起搏需要，以及当地批准的具体型号说明。 本片介绍 Micra AV2 和 Micra VR2，两者的适应证和功能不能混同。 两款均不能给心房起搏，也不能单独提供心脏再同步治疗或除颤。 窦房结功能障碍患者需经过选择；传统双腔起搏器难以植入、风险较高，或治疗上并不需要时，才考虑相应方案。 中文版本说明 中文旁白与画面改编自最终英文版，保留患者选择条件、操作顺序、严重风险及长期随访要点。 旁白为经授权以黄医生提供的录音制作的 AI 声音重现，并非医生逐字实录。 临床照片由黄医生提供。画面避开患者身份信息；品牌标识不表示医院或厂商背书。 动画为概念示意，经过解剖裁切与运动简化，并非患者影像，也不是实际尺寸。 解剖模型署名 BodyParts3D，© The Database Center for Life Science，依据 CC BY 4.0 国际许可使用与改编。 https://dbarchive.biosciencedbc.jp/en/bodyparts3d/lic.html https://creativecommons.org/licenses/by/4.0/ 完整改编说明及英文原始参考资料如下。 MICRA AV2 AND VR2 LEADLESS PACEMAKERS Sources and acknowledgements Dr Ng Kim Fong • Patient education • 17 October 2026 PURPOSE This video is a general educational summary, not individual medical advice, operator training or a substitute for informed consent. The choice of pacemaker depends on the patient's rhythm, heart function, expected pacing needs and locally approved device labeling. This video concerns Micra AV2 and Micra VR2. Their capabilities and indications are not interchangeable; older Micra AV/VR references provide background, not substitutes for model-specific labeling. CLINICAL REFERENCES 1. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy, developed with EHRA contribution; section 7.4. https://academic.oup.com/eurheartj/article/42/35/3427/6358547 Supports considering leadless pacing in selected patients, including unavailable upper-extremity venous access or particularly high pocket-infection risk (Class IIa, level B). Use as an alternative to standard single-lead ventricular pacing is Class IIb, level C, considering life expectancy and shared decision-making. This predates AV2/VR2 and is not a model-specific endorsement. 2. Boersma et al. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices. Joint EHRA/HRS/LAHRS/APHRS position paper. Europace 2022;24:1691–1708. https://doi.org/10.1093/europace/euac066 Addresses selection, procedural planning, imaging, follow-up and limitations. 3. 2018 ACC/AHA/HRS Guideline on Bradycardia and Cardiac Conduction Delay. https://professional.heart.org/en/science-news/2018-guideline-for-the-evaluation-and-management-of-bradycardia-and-cardiac-conduction-delay/top-things-to-know Provides the broader clinical basis for deciding when pacing is indicated. 4. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing. https://www.hrsonline.org/wp-content/uploads/2025/02/2023-HRS-APHRS-LAHRS-CCP-Guideline.pdf 2025 ESC consensus on conduction-system pacing, with EHRA contribution and HRS endorsement. https://pmc.ncbi.nlm.nih.gov/articles/PMC11957271/ Relevant to alternatives where heart function and expected ventricular pacing burden favor another pacing approach. 5. Medtronic Micra patient explanation and safety information. https://www.medtronic.com/en-gb/l/patients/treatments-therapies/pacemaker/micra.html https://www.medtronic.com/en-gb/l/patients/treatments-therapies/pacemaker/important-safety-information/micra-important-safety-information.html Supports the usual venous catheter route to the right ventricle, flexible-tine fixation, testing before release and the discussion of complications. 6. Malaysia Medical Device Authority public registration: Micra AV2 (MC2AVR1) and Micra VR2 (MC2VR01). https://mdar.mda.gov.my/frontend/web/index.php?id=101016&r=carian%2Freport The official record's indexed text lists registration validity from 12 July 2024 to 11 July 2029. Detailed indexed text was accessible during this review; the direct page could not be retrieved. Registration does not establish current hospital stock. Confirm current local instructions before clinical use. 7. Medtronic model-specific indications and safety information. Micra VR2: https://www.medtronic.com/en-us/healthcare-professionals/products/cardiac-rhythm/pacing-systems/pacemakers/micra-vr2-leadless-pacemaker.html Micra AV2 labeling comparison: https://www.medtronic.com/en-us/healthcare-professionals/product-resources/scientific-publications/cardiac-rhythm-management/micra-av-micra-av2-leadless-pacemakers-concomitant-use-atrial-pacing-device.html Asia-region manufacturer safety statement including AV2/VR2 model numbers: https://europe.medtronic.com/in-en/healthcare-professionals/products/cardiac-rhythm/pacemakers/micra-pacing-system/indications-safety-warnings.html MODEL-SPECIFIC SELECTION AND LIMITATIONS Micra VR2 provides ventricular pacing. Its labeling includes high-grade AV block with AF; selected high-grade AV block without AF; and selected symptomatic sinus-node dysfunction or bradycardia-tachycardia syndrome. For the latter two groups, it is an alternative when conventional dual-chamber transvenous pacing is difficult, high risk or unnecessary for effective therapy. This is not a blanket recommendation for all sick-sinus patients. Micra AV2 provides mechanically atrial-tracking ventricular pacing for selected patients with high-grade AV block when a conventional dual-chamber transvenous system is a poor option or unnecessary and AV synchrony at rest is acceptable. The listed rhythm settings include absence of AF, paroxysmal AF, or persistent AF when restoration of sinus rhythm is still planned. It is not a general sinus-node-dysfunction indication. Neither model paces the atrium. AV2 senses atrial mechanical activity; coordination can vary with physiology, activity and heart rate. Patients who need atrial pacing may require a different system. Micra alone does not provide cardiac resynchronization or defibrillation. Heart function and expected ventricular pacing burden remain important to selection. Advanced/high-grade AV block and complete AV block are not identical terms. The narration uses “advanced or complete heart block.” Rate-responsive pacing is a feature that increases the paced rate with activity, not a separate rhythm diagnosis. Risks include bleeding or vascular injury, cardiac perforation and bleeding/fluid around the heart, device movement, infection, thrombosis and pacing problems. Major complications may require urgent treatment and can be life-threatening. Battery depletion requires an individualized treatment decision. No model-specific risk percentage or guaranteed battery duration is claimed. VISUAL AND AUDIO ACKNOWLEDGEMENTS Clinical photographs supplied by Dr Ng Kim Fong. Patient screen identifiers are excluded from the displayed images. Selected photographs are used to keep the video focused. Photographs supplied with hospital branding are not evidence of endorsement or a claim about clinical outcomes. BodyParts3D, © The Database Center for Life Science licensed under CC Attribution 4.0 International. https://dbarchive.biosciencedbc.jp/en/bodyparts3d/lic.html https://creativecommons.org/licenses/by/4.0/ https://dbarchive.biosciencedbc.jp/en/bodyparts3d/description.html Geometry retrieval mirror: https://github.com/olivercase/body_parts_3d_api The official license page was updated on 27 February 2025; the mirror retains older license metadata. Adaptations include recentering/scaling, anterior cutaway, omission of the anterior tricuspid leaflet, shading, camera composition, catheter/device/venous-route overlays and animation. No endorsement by DBCLS or mirror contributors is implied. The animation is an original conceptual illustration, not patient-specific imaging or manufacturer CAD. Some anatomy is removed to show the pathway. Illustrative device and catheter sizes are not to scale. Motion details are simplified; contact force, tissue deformation, fixation security and electrical testing are not simulated. Device dimensional reference: https://www.medtronic.com/content/dam/medtronic-wide/public/united-states/products/cardiac-vascular/cardiac-rhythm/pacing-systems/micra-vr2-spec-sheet.pdf Existing videos consulted as references, not copied: Medtronic Cardiac and Vascular, Micra TPS Implant Procedure Animation: https://www.youtube.com/watch?v=R64Fw9zaq-M Medtronic Micra AV animation gallery: https://news.medtronic.com/gallery?item=39 Narration is an AI recreation of Dr Ng's supplied voice, used with permission. Clinical and regulatory information should be checked for the specific model and location before treatment decisions.