The objective of this Investigational Device Exemption trial is to confirm the safety and performance of the LivIQ leadless pacemaker system, in patients with a Class I or II indication for ventricular pacing (VVI/VDD) according to applicable guidelines. An integrated atrioventricular synchrony sub-study (AVS) is specifically designed to evaluate the AVS performance of the LivIQ system.

BIO-LivIQ is designed as an open-label, prospective, single-arm, multi-center, international study. A total of 325 subjects will be enrolled across up to 60 centers from the U.S., Europe, and Asia Pacific.

Within the study, identified patients will be enrolled after a medical record review to determine if all inclusion criteria and no exclusion criteria are met. Once informed consent is obtained, subjects will be examined on-site at enrollment, implant, pre-hospital discharge, 1 month, 3 months, 6 months and 12 months , with continued in-person follow-up every 6 months until regional market approval. After U.S. market approval, a required remote 24-month visit will be conducted to assess vital status.

The performance of VDD pacing will be evaluated in the AVS sub-study. Once informed consent is obtained for this sub-study, AVS Holter data will be collected at 1-month and 6-month follow-ups.

Inclusion criteria:

1. Class I or Class II indication for ventricular pacing (VVI/VDD) according to applicable guidelines
2. Age is greater than or equal to 18 years at time of consent
3. Able to understand the nature of the study and provide written informed consent
4. Able and willing to complete all study requirements, including completion of all planned in-office study visits, for the expected duration of follow-up

Exclusion criteria:

1. AV block with a ventricular escape rhythm ≤ 30 bpm at time of consent Note: Restriction removed after early safety phase objectives are met
2. Femoral venous anatomy that is unable to accommodate the introducer or the cardiac anatomy does not allow a leadless pacemaker in the right ventricle
3. Morbid obesity which may prevent the LivIQ device from obtaining telemetry communication within a range of 20 cm, in the physician's judgement
4. Intolerance of dexamethasone acetate
5. Other implanted devices that, in the judgement of the implanting physician, could interfere (mechanically or electrically) with the leadless pacemaker or with the implant procedure
6. Allergy to the materials of the leadless pacemaker or the implant tools that are in contact with the human body
7. Prior leadless pacemaker implant attempt
8. Existing transvenous or leadless pacemaker, transvenous or subcutaneous ICD, or CRT device or previous extraction in which transvenous leads (full or partial) were left in the heart Note: Exception given to use temporary transvenous pacemakers
9. CIED device extraction within the previous 72 hours or signs of active infection after CIED extraction Note: Patients with extraction due to potential systemic infection must have a blood culture. A blood culture is considered negative if there is no growth within 72 hours prior to the LivIQ implant.
10. Planned ICD or CRT device implant
11. Unstable angina pectoris or acute myocardial infarction within 30 days prior to enrollment
12. Life expectancy of less than 12 months
13. Unable to tolerate an urgent sternotomy
14. Planned right-sided heart intervention within 30 days after implant Note: Exception given to AV nodal ablations when performed by an implanting investigator once early safety phase objectives are met
15. Listed for or has received a heart transplantation or has a left ventricular assist device (LVAD)
16. Participation or plan to participate in any other potentially confounding investigational drug or device trial, or any other clinical trial that may interfere with this study's treatment or protocol during the duration of the study Note: Co-enrollment in concurrent trials is only allowed when documented prior approval is obtained from BIOTRONIK
17. Unable to attend in-person planned or emergent study site visits (e.g., frequent or extended travel plans)
18. Pregnant or plan to become pregnant during the duration of the study

AVS Sub-Study Inclusion Criteria:

After consenting to the main study, patients potentially eligible for the AVS Sub-Study must meet these additional criteria:

1. Willing and able to perform the requested procedures for the AVS assessments
2. Current or history of AV block Note: This includes patients with any degree or type of AV block, irrespective of related symptoms and relevance of the AV block for the underlying pacemaker indication

AVS Sub-Study Exclusion Criteria:

After consenting to the main study, patients potentially eligible for the AVS Sub-Study must not meet the following criterion:

1. Permanent AF

Applicable de-identified individual participant data will be made available to achieve aims in approved proposals, including but not limited to sub-analysis or meta-analysis.

Beginning no later than 12 months and ending no earlier than 3 years following initial publication of clinical study results.

Researchers who provide a methodologically sound proposal for analysis that is not pre-planned or already approved with another researcher. Proposals must be approved by BIOTRONIK and Study Principal Investigator.

Proposals should be directed to BIOTRONIK Clinical Studies (BIOTRONIK Inc., Attn: Clinical Studies, 6024 Jean Road, Lake Oswego, OR 97035; 1-800-547-0394). To gain access, data requesters will need to sign a data use/access agreement.