Pacing And Clinical Electrophysiology[JOURNAL]
Sun
200 papers
Successful CRT Reimplantation After Coronary Sinus Total Occlusion Using CTO Wire Escalation Techniques: A Case Report.
Erdoğdu OU, Ersoysal MR
Pacing Clin Electrophysiol · 2026 Jun · PMID 41705386 · Publisher ↗
Coronary sinus (CS) abnormalities represent a major technical challenge during cardiac resynchronization therapy (CRT) reimplantation following transvenous lead extraction. Complete CS occlusion may preclude left ventric...
Coronary sinus (CS) abnormalities represent a major technical challenge during cardiac resynchronization therapy (CRT) reimplantation following transvenous lead extraction. Complete CS occlusion may preclude left ventricular (LV) lead delivery and often necessitates alternative pacing strategies or surgical epicardial lead placement. We report a case of successful CRT reimplantation in a patient with complete CS occlusion encountered during a right-sided approach. The occlusion was crossed using a stepwise guidewire escalation strategy adapted from chronic total occlusion (CTO) percutaneous coronary intervention techniques, followed by sequential balloon venoplasty. Despite the occurrence of a long-segment CS dissection, the LV lead was successfully advanced and implanted with stable electrical parameters. This case illustrates that selected CS occlusions during CRT procedures may be managed percutaneously using contemporary interventional tools and techniques.
Left Atrial Epicardial Adipose Tissue Associated With Persistent AF Termination During Pulmonary Vein Isolation.
Qiu B, Shen J, Chen L … +6 more , Sang C, Yang D, Ding S, Wang X, Chen W, Zhang C
Pacing Clin Electrophysiol · 2026 May · PMID 41704073 · Publisher ↗
BACKGROUND: Termination of persistent atrial fibrillation (PersAF) during radiofrequency catheter ablation (RFCA) is closely related to the outcome of the ablation. Epicardial adipose tissue (EAT) plays an important role...
BACKGROUND: Termination of persistent atrial fibrillation (PersAF) during radiofrequency catheter ablation (RFCA) is closely related to the outcome of the ablation. Epicardial adipose tissue (EAT) plays an important role in the maintenance of AF. The role of EAT on the termination of PersAF has not been reported. The aim of this study was to evaluate the association between left atrial EAT (LA-EAT) and termination of PersAF during pulmonary vein isolation (PVI). METHODS: This was a single-center retrospective observational study. Consecutive enrolment of PersAF who underwent first-time radiofrequency ablation between January 2021 and August 2022. All patients underwent computed tomography angiography (CTA) examination of the left atrium, and the LA-EAT was measured using medical software (Advantage Workstation 4.6, GE, USA). Termination of PersAF during ablation was defined as conversion of AF to sinus rhythm (SR) or stable atrial flutter (AFL)/atrial tachycardia (AT). RESULTS: A total of 203 PersAF patients were enrolled, atrial fibrillation rhythm termination during PVI in 42 patients. Multivariate analysis showed that duration of AF, Heart failure (HF), and LA-EAT volume (OR = 0.960; 95%CI: 0.926- 0.996, p = 0.029) were independent predictors of termination. ROC analysis showed that the model including AF duration, HF, and LA-EAT had an effective ability to predict the termination (AUC = 0.734, 95% CI:0.647-0.802, p < 0.001). When LA-EAT was integrated into the model of characteristics routinely (including AF duration and HF), the discrimination and reclassification accuracy for the termination were significantly improved (NRI 0.2143, 95% CI 0.0724-0.3562, p = 0.003; IDI 0.0291, 95% CI 0.0047-0.0535, p = 0.019). The analysis revealed a statistically significant difference in overall arrhythmia recurrence between the termination group and non-termination group (log-rank p = 0.038). CONCLUSION: LA-EAT is independently associated with the termination of PersAF during PVI CLINICAL TRIAL NUMBER: Not applicable.
Epicardial Sinus Node Modification Using 5% Dextrose Insulation to Prevent Phrenic Nerve Injury: A Case Report.
Özgeyik M, Eşki RA, Yıldırım ÖT … +2 more , Demirel A, Candemir B
Pacing Clin Electrophysiol · 2026 Jun · PMID 41704068 · Publisher ↗
BACKGROUND: Sinus node modification for drug-refractory inappropriate sinus tachycardia (IST) is limited by the risk of phrenic nerve injury, particularly when the target substrate is located along the high right atrium...
BACKGROUND: Sinus node modification for drug-refractory inappropriate sinus tachycardia (IST) is limited by the risk of phrenic nerve injury, particularly when the target substrate is located along the high right atrium and superior vena cava region. Various mechanical and electrical strategies have been proposed to mitigate this risk; however, effective insulation of the phrenic nerve during epicardial ablation remains challenging. CASE SUMMARY: We report a patient with highly symptomatic, drug-refractory IST who underwent sinus node modification after failure of conventional endocardial ablation. Due to persistent phrenic nerve capture at the intended ablation sites, a percutaneous epicardial approach was undertaken. Injection of 5% dextrose in water (D5W) into the pericardial space was used as an electrically insulating medium to displace and protect the phrenic nerve, allowing effective epicardial radiofrequency delivery without phrenic nerve injury. Acute procedural success was achieved, with a significant reduction in sinus rate and symptomatic improvement during follow-up. COMPLICATIONS: The post-procedural course was complicated by a localized pericardial effusion and dense pericardial adhesions observed during re-intervention. These findings were managed conservatively and are discussed as potentially related to procedural factors, including extensive epicardial ablation and local inflammatory response, rather than attributed to a single causative mechanism. CONCLUSION: This case illustrates the feasibility of using D5W as an epicardial insulating medium to facilitate sinus node modification in close proximity to the phrenic nerve. While effective phrenic nerve protection was achieved, the occurrence of pericardial complications underscores the need for cautious patient selection, meticulous procedural technique, and further evaluation of safety strategies when employing non-physiologic insulating solutions in the epicardial space.
Antibacterial Envelope Use in Cardiac Implantable Electronic Devices: A Systematic Review and Meta-Analysis.
Papadopoulos GE, Pentousis P, Ninios I … +4 more , Evangelou S, Ioannides A, Pentousis D, Ninios V
Pacing Clin Electrophysiol · 2026 Jun · PMID 41703424 · Publisher ↗
BACKGROUND: Antimicrobial envelopes are increasingly used to prevent cardiac implantable electronic device (CIED) infections, but prior meta-analyses-performed largely before the accumulation of contemporary cohorts-repo...
BACKGROUND: Antimicrobial envelopes are increasingly used to prevent cardiac implantable electronic device (CIED) infections, but prior meta-analyses-performed largely before the accumulation of contemporary cohorts-reported heterogeneous effects and limited exploration of effect-modifiers. OBJECTIVE: To update the evidence on antibacterial envelope effectiveness using contemporary studies and standardized infection definitions, and to quantify absolute and relative risk reductions across clinically relevant subgroups (device power, de novo vs. reintervention) with rigorous bias and robustness analyses. METHODS: We conducted a systematic review and meta-analysis adhering to PRISMA. We included randomized and observational studies comparing absorbable antibiotic-eluting or antibacterial envelopes versus standard care at CIED implantation or revision. "Major CIED infection" was prespecified per international consensus criteria. We used Mantel-Haenszel random-effects models, prespecified subgroup analyses, leave-one-out sensitivity analyses, and GRADE. Risk of bias was assessed with RoB2/ROBINS-I. RESULTS: Seven studies (13,306 patients; one randomized trial, six observational cohorts) met inclusion criteria. Antibacterial envelope use significantly reduced overall CIED infection (OR 0.55, 95% CI 0.33-0.92; p = 0.02), driven by a marked reduction in pocket infections (OR 0.32, 95% CI 0.19-0.52; p < 0.01). Systemic infection (OR 1.33, 95% CI 0.46-3.81; p = 0.60) and all-cause mortality (OR 0.83, 95% CI 0.59-1.19; p = 0.32) were not significantly affected. Benefits were most pronounced in high-risk subgroups. CONCLUSION: Antibacterial envelopes substantially reduce pocket-related CIED infections without altering systemic infection or mortality. These findings support their selective use in patients at elevated risk, particularly those undergoing generator replacement, pocket revision, or CRT implantation.
Hemodynamics During Pulsed-Field Ablation: A Deep Dive Into Its Temporal Aspect in Various Sedation Strategies.
Hozman M, Waldauf P, Sochorová V … +4 more , Kunštátová V, Duška F, Heřman D, Osmančík P
Pacing Clin Electrophysiol · 2026 Mar · PMID 41693446 · Publisher ↗
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Safety and Efficacy of MA01-100: A Prospective Multicenter Trial of China's First Domestic Implantable Cardiac Monitor.
Xu L, Xu Z, Qin S … +14 more , Zhang L, Bai J, Wang W, Li R, Wang J, Zhang H, Li H, Xu W, Liu Y, Wang S, Ping L, Chen X, Su Y, Ge J
Pacing Clin Electrophysiol · 2026 Jun · PMID 41686080 · Full text
BACKGROUND: Unexplained syncope and palpitations are common chief complaints in the outpatient department of cardiology. Their sporadic and unpredictable poses significant diagnostic challenges. Implantable cardiac monit...
BACKGROUND: Unexplained syncope and palpitations are common chief complaints in the outpatient department of cardiology. Their sporadic and unpredictable poses significant diagnostic challenges. Implantable cardiac monitors (ICMs) can monitor arrhythmia events efficiently, and can overcome the shortcomings of traditional electrocardiogram (ECG) detection tools such as Holter. However, the high cost of imported ICM devices limits accessibility for patients in China. The MA01-100 (Singular Medical, Suzhou, China), the first domestically developed ICM, may offer a cost-effective alternative. This study aimed to evaluate the safety and efficacy of the MA01-100 compared with standard surface electrocardiography (ECG) for arrhythmia monitoring in Chinese patients. METHODS: A prospective, paired design trial was conducted across six hospitals in China. Sixty-four participants underwent implantation of the MA01-100 ICM device. As the self-control group, patients were also assessed using a surface ECG at implantation, and 30- and 90-day follow-ups. The primary efficacy endpoints were the sensitivity and positive predictive value (PPV) of R wave detection at 30 days post-implantation. Secondary endpoints included R wave amplitude stability, QRS complex morphology consistency, arrhythmia event detection rate, arrhythmia event identification accuracy, clinical performance evaluation of the programmer, and remote transmission function assessment. Safety was evaluated by the incidence rates of major adverse events (MAEs), serious adverse events (SAEs), and device defects within 3 months of follow-up. RESULTS: All 64 patients who met the inclusion criteria were enrolled in the trial. They underwent successful cardiac monitor implantation with acceptable sensitivity and PPV of R wave detection. The mean sensitivity was 99.98 ± 0.10%, with a minimum of 99.34%. The two-sided 95% confidence interval (CI) for the compliance rate was (94.40%-100.00%). The mean PPV was 99.94 ± 0.35%, with a minimum of 97.35%. The two-sided 95% CI for the compliance rate was (94.40%-100.00%). Two patients (3.1%) experienced mild implantation site infections; no device defects or SAEs were observed. All pre-defined efficacy and safety benchmarks were met. CONCLUSION: This study provides the first prospective, multicenter clinical evaluation of the safety and efficacy of an intracardiac monitor (ICM) independently developed in China. It systematically validated the device's clinical performance, thereby filling the gap in China's ICM field across the entire chain of "independent development-clinical validation-translational application." The results demonstrate that the ICM meets the requirements for clinical use, providing new support for improving the accessibility of arrhythmia diagnostic services in China and offering a reference for formulating globally cost-effective cardiac monitoring strategies.
Pacing Ratio Changes of an Implanted Permanent Pacemaker After Transcatheter Aortic Valve Implantation.
Fukuoka Y, Ikeda Y, Mori H … +8 more , Matsuo K, Arai T, Kato R, Nakano S, Yoshitake A, Yamazaki H, Yamazaki H, Koga Y
Pacing Clin Electrophysiol · 2026 Jun · PMID 41686077 · Full text
BACKGROUND: In some patients, transcatheter aortic valve implantation (TAVI) is associated with conduction disturbances, necessitating permanent pacemaker implantation (PMI). The clinical course of conduction disturbance...
BACKGROUND: In some patients, transcatheter aortic valve implantation (TAVI) is associated with conduction disturbances, necessitating permanent pacemaker implantation (PMI). The clinical course of conduction disturbances after PMI, based on the type of TAVI valve, remains unclear. Therefore, the present study aimed to evaluate the effects of different types of TAVI valves on the clinical course of conduction disturbances. METHODS: In total, 480 patients, including 230 with self-expandable (SE) valves and 250 with balloon-expandable (BE) valves, who underwent TAVI between January 2016 and December 2024, were enrolled in this study. The characteristics of patients who required PMI and the changes in the ventricular pacing ratio were compared. RESULTS: There was no significant difference in PMI factors depending on the type of valve. Computed tomography (CT) images showed that the length of the membranous septum (MS) in the PMI group did not differ from the length of the MS in the non-PMI group. There was a significant difference in improvement in autologous AV conduction between the SE and BE groups at PMI time (SE group vs. BE group; 11/15 [66.7%] vs. 3/11 [27.3%], p = 0.047). At 1 month follow-up, the SE group improved significantly compared to the BE group (SE vs. BE; 14/15 [93.3%] vs. 4/11 [33.3%], p = 0.002). CONCLUSION: Restoration of autologous AV conduction and subsequent decrease in ventricular pacing ratio were more likely in the SE group and less variable in the BE group. This result indicates that PM dependency can be reduced by using an extended AVD setting or AVH.
Impact of Pulmonary Vein Anatomy on Outcomes in Patients Undergoing Cryoballoon Ablation for Atrial Fibrillation.
Keresteci AH, Çöteli C, Ateş AH … +4 more , Ardalı Düzgün S, Hazırolan T, Yorgun H, Aytemir K
Pacing Clin Electrophysiol · 2026 Jun · PMID 41685520 · Publisher ↗
BACKGROUND: Effective pulmonary vein isolation (PVI) using cryoballoon (CB) ablation relies on adequate pulmonary vein (PV) occlusion, which may be influenced by PV and left atrial (LA) anatomy. OBJECTIVES: To evaluate t...
BACKGROUND: Effective pulmonary vein isolation (PVI) using cryoballoon (CB) ablation relies on adequate pulmonary vein (PV) occlusion, which may be influenced by PV and left atrial (LA) anatomy. OBJECTIVES: To evaluate the impact of PV and LA anatomy, assessed by cardiac computed tomography (CT), on long-term outcomes and complications following CB ablation for AF. METHODS: This retrospective study included 416 patients (54.8% female, mean age 57.5 ± 12.4 years) who underwent CB ablation for symptomatic AF. Paroxysmal AF was present in 87% and persistent AF in 13% of patients. Arctic Front Advance or Arctic Front Advance PRO catheters were used. All patients had preprocedural cardiac CT. AF recurrence and procedural complications were evaluated over a median follow-up of 46.5 months (range: 6-116). RESULTS: Freedom from AF was observed in 73.1% of patients during follow-up. Multivariable Cox regression analysis revealed that the maximum diameter of right superior PV (RSPV) (HR: 1.076, 95% CI: 1.003-1.154, p = 0.040) and the frontal angle of the left superior PV (LSPV) (HR:0.984, 95% CI: 0.968-0.999, p = 0.048) were independent predictors of recurrence. Independent predictors of phrenic nerve injury included the frontal angle of the RSPV (OR: 1.072, 95% CI: 1.020-1.126, p = 0.006) and the distance between the RSPV and the right phrenic nerve bundle (OR: 0.327, 95% CI: 0.188-0.579, p < 0.001). CONCLUSION: Specific PV anatomical features influence AF recurrence and PNI after CB ablation. Preprocedural cardiac CT may help tailor ablation strategies and optimize patient outcomes.
Delayed CAVB After SP Ablation for AVNRT: Mechanistic Insights Into FP Injury and Pacing Decision-Making.
Honda N, Ogawa K, Tasaki K … +3 more , Hino M, Kodama T, Masuda S
Pacing Clin Electrophysiol · 2026 May · PMID 41685396 · Full text
As standard therapy for atrioventricular nodal re-entrant tachycardia (AVNRT), radiofrequency ablation of the antegrade slow pathway (SP) is associated with a low risk of AV block. Delayed complete AV block (CAVB), howev...
As standard therapy for atrioventricular nodal re-entrant tachycardia (AVNRT), radiofrequency ablation of the antegrade slow pathway (SP) is associated with a low risk of AV block. Delayed complete AV block (CAVB), however, is a rare but clinically challenging complication, particularly concerning permanent pacemaker decision-making. A 79-year-old man with pre-existing first-degree AV block developed delayed CAVB 1 day after successful SP ablation for typical AVNRT. Transient PR interval shortening immediately post-ablation preceded progression to high-grade AV block. Subsequently, AV conduction gradually recovered without permanent pacemaker implantation, as confirmed using serial electrocardiography, treadmill exercise testing, and repeat electrophysiological studies. Electrophysiological evaluation showed impaired antegrade fast pathway (FP) conduction with complete absence of retrograde ventriculoatrial conduction, suggesting differential involvement of FP fibers. Delayed AV block after SP ablation may be reversible, particularly when preceded by PR interval shortening and when AV conduction improves under exercise or pharmacological stress. Careful functional assessment of AV conduction is needed before committing to permanent pacemaker implantation, as delayed AV block may reflect indirect and potentially reversible FP injury.
What to Do When Bumping Impairs Conduction of an Accessory Pathway?
Bencsik G, Pap R
Pacing Clin Electrophysiol · 2026 Apr · PMID 41662286 · Publisher ↗
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Balloon-Shaped Pulsed Field Ablation for Pulmonary Vein Isolation and Atrial Lesions.
Zuo S, Sang C, Wang J … +15 more , Kong X, Zhang J, Gao M, Dai W, Zhang J, Guo X, Liu X, Zhou N, Li S, Huang L, Mo Z, Chen H, Liu N, Dong J, Ma C
Pacing Clin Electrophysiol · 2026 May · PMID 41662284 · Publisher ↗
INTRODUCTION: The cryoballoon catheter is a gold-standard single-shot device for pulmonary vein isolation (PVI). Pulsed-field ablation (PFA) is a tissue-selective, nonthermal cardiac ablation modality. We assessed the pr...
INTRODUCTION: The cryoballoon catheter is a gold-standard single-shot device for pulmonary vein isolation (PVI). Pulsed-field ablation (PFA) is a tissue-selective, nonthermal cardiac ablation modality. We assessed the preclinical safety and durability of a novel conformal, balloon-shaped, single-shot PFA catheter for PVI and circular atrial lesions. METHODS: A 13 Fr balloon-shaped PFA catheter (PFBalloon, 20 electrodes, 24 mm diameter, EnChannel Medical) was applied using a biphasic waveform of microsecond scale (± 750 V, 4.9 s per application). In 10 swine, superior vena cava (SVC), left superior PV (LSPV), right superior PV (RSPV) and right atrial appendage (RAA) were targeted for isolation. Localization of PFBalloon was evaluated by fluoroscopy and intracardiac echocardiography (ICE). PFA was delivered in a novel tailored configuration (small ring, large ring, or global pulse) to minimize diaphragm stimulation and optimize pulse efficiency. Five swine were assessed at 30 days post-procedure for lesion durability, gross pathology, and histologic examination, while the remaining five swine were evaluated at 90 days to assess longer term outcomes. RESULTS: In all 10 swine, PFA resulted in 100% successful acute isolation of the SVC, RSPV, and LSPV using 4.2 ± 0.6, 5.0 ± 1.1, and 4.4 ± 1.8 applications per vein, respectively, and acute isolation of RAA in 9/10 swine using 5.3 ± 2.0 applications. At 30 days post-procedure, 14 out of 20 targeted sites (70.0%) remained isolated in five pigs. At 90 days, 19 out of 20 sites (95.0%) remained isolated in the remaining five pigs. The overall pulse configurations were 9.0% small ring, 25.4% large ring, and 65.6% global. PFA did not affect phrenic nerve function, with very few microbubbles recorded on ICE. No major complications were observed. CONCLUSIONS: In this preclinical study, a novel conformal, balloon-shaped catheter designed for single-shot PVI can create durable isolation without complications.
Inappropriate Ventricular Pacing With Exercise in an 11-Year-Old Girl With a History of Idiopathic Paroxysmal AV Block.
Kramer C, Karolcik B, Beerman L … +2 more , Follansbee C, Arora G
Pacing Clin Electrophysiol · 2026 Apr · PMID 41662203 · Full text
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Technical Feasibility of the RHYTHMIA Mapping System in Pediatric Patients Weighing Less Than 20Kg.
Sasaki W, Nabeshima T, Nagaoka K … +10 more , Mori H, Kudo D, Tanaka N, Naganuma T, Narita M, Matsumoto K, Ikeda Y, Sumitomo N, Matsumoto K, Kato R
Pacing Clin Electrophysiol · 2026 May · PMID 41640112 · Full text
BACKGROUND: Catheter ablation in pediatric patients remains technically challenging. The RHYTHMIA high-density mapping system is increasingly used in pediatric electrophysiology; however, procedural experience in patient...
BACKGROUND: Catheter ablation in pediatric patients remains technically challenging. The RHYTHMIA high-density mapping system is increasingly used in pediatric electrophysiology; however, procedural experience in patients weighing less than 20 kg is limited. METHODS: We retrospectively analyzed 125 pediatric patients who underwent catheter ablation for supraventricular arrhythmias using the RHYTHMIA system. The patients were divided into two groups according to body weight: ≥20 kg group (n = 111) and the <20 kg group (n = 14). The mapping time, number of mapping beats, and mapping electrodes were compared for the right atrium (RA), and left atrium (LA), along with the manual re-annotation points and incidence of complications. RESULTS: A total of 184 maps were analyzed. No significant differences were found in mapping time, accepted beats, and electrograms (RA, ≥20 kg group [n = 104] vs. <20 kg group [n = 11]; mapping time, 13.8 min[10.1-18.3] vs. 17.4 min[9.4-25.3], p = 0.95; accepted beats, 744 beats[548-1095] vs. 953 beats[654-1079], p = 0.57; electrograms, 6871 electrograms[5074-10885] vs. 6650 electrograms[4474-9527], p = 0.30) (LA, ≥20 kg group [n = 62] vs. <20 kg group [n = 7]; mapping time, 11.5 min[8.1-18.3] vs. 14.5 min[8.5-15.4], p = 0.97; accepted beats, 619 beats[354-1007] vs. 512 beats[316-810], p = 0.89; electrograms, 6809 electrograms[4025-10108] vs. 4338 electrograms[3369-8693], p = 0.93). In the RA, <20 kg group required more re-annotations than ≥20 kg group, while no significant differences in complications were observed between the groups. CONCLUSIONS: Use of the RHYTHMIA mapping system in carefully selected pediatric patients weighing less than 20 kg was technically feasible and not associated with major procedural complications. These findings support its cautious use with appropriate case selection and operator vigilance.
Jugular Journeys: A Novel Approach for AVEIR Leadless Pacemaker Implantation.
Saleem-Talib S, Hoevenaars CPR, Blok IM … +4 more , Driel VJV, Heijden JFV, Groot NMS, Ramanna H
Pacing Clin Electrophysiol · 2026 Jun · PMID 41631654 · Full text
BACKGROUND: The jugular approach for Micra leadless pacemaker (LP) implantation offers potential advantages over the femoral route, however data on safety and feasibility for the relatively larger AVEIR LP implantation t...
BACKGROUND: The jugular approach for Micra leadless pacemaker (LP) implantation offers potential advantages over the femoral route, however data on safety and feasibility for the relatively larger AVEIR LP implantation through the jugular vein is limited. This study evaluated the procedural safety and short-term clinical outcomes of AVEIR ventricular LP implantation via the internal jugular vein (IJV). METHODS: All consecutive patients undergoing AVEIR LP implantation via the IJV at our center between November 2023 and July 2025 were included. Procedural details, device electrical parameters and complications were collected from patient electronic records. RESULTS: Eighteen patients (median age 76 years, 33% female) had an AVEIR LP implantation via the IJV. Implantation was successful in 17/18 patients (94%). The median duration of the procedures was 65.5 min (45.0-134.0) with a median fluoroscopy time of 11.2 min (7.4-42.3). Median follow-up time was 9.9 months (0.6-19.5). During follow up the device electrical parameters remained stable with, mean R-wave amplitude 8.83 mV ± 3.6, pacing threshold 0.75 V. ± 0.4 V and impedance 730 ± 338 Ω; with an average estimated battery longevity of 16.0 ± 4.5 years. Two minor procedural complications occurred: one requiring conversion to femoral access, and one requiring an additional transvenous pacemaker lead due to elevated pacing thresholds. No vascular complications were observed. CONCLUSION: AVEIR ventricular LP implantation via the IJV is safe and feasible, with stable electrical performance, during short-term follow-up. While the larger device size may challenge AVEIR implantations in smaller hearts, using the delivery sheath as a support to create a sharper curve facilitates the procedure.
Sex-Related Differences in Outcomes of Left Atrial Appendage Occlusion Device Placement.
Ali S, Duhan S, Badu I … +13 more , Kumar M, Alsaeed T, Farooq F, Keisham B, Bahar AR, Atti L, Ponna PK, Sewell M, Brar V, Agrawal P, Helmy T, Asad ZUA, Dominic P
Pacing Clin Electrophysiol · 2026 Apr · PMID 41631647 · Publisher ↗
BACKGROUND: Atrial fibrillation (AF) is associated with profound morbidity and mortality, including a fivefold increase in stroke risk. Left atrial appendage occlusion (LAAO) devices have emerged as an alternative approa...
BACKGROUND: Atrial fibrillation (AF) is associated with profound morbidity and mortality, including a fivefold increase in stroke risk. Left atrial appendage occlusion (LAAO) devices have emerged as an alternative approach to anticoagulation in patients with elevated bleeding risk and/or have contraindications to anticoagulation. However, females have been underrepresented in PROTECT & PREVAIL landmark trials supporting LAAO use. We aim to compare gender differences in outcomes of LAAO occlusive devices. METHODS: The national readmission database (2016-2020) was utilized to identify hospitalizations for LAAO placement. Cohorts were stratified by gender as males and females. A propensity score matching (PSM) model matched both cohorts. Pearson's x2 test was applied to the matched cohorts to compare outcomes. RESULTS: Among 89,552 hospitalizations for LAAO placement, 41.3% of procedures were performed in females. Females were found to have a lower prevalence of co-morbidities such as diabetes, hypertension, hyperlipidemia and CKD [p < 0.001]. After propensity matching (N = 20,627), females had higher adverse events, including mortality (0.23% vs. 0.15%, p: 0.041), sudden cardiac arrest (1.77% vs. 1.37%, p: 0.001), pericardial complications (1.46% vs. 0.86%, p < 0.001), cardiac tamponade (0.94% vs. 0.54%, p < 0.001), post-procedural bleeding (0.69% vs. 0.53%, p: 0.032) & net adverse events (4.73% vs. 4.24%, p < 0.001). At six-month follow-up post-procedure, females had higher readmission rates at 30 days (9.42% vs. 8.07%, p < 0.001), 90-day and 180-day intervals (p < 0.001). CONCLUSION: In patients with hospitalizations for LAAO device placement, we observed a higher risk of net adverse events and mortality in females following the procedure compared to males. Prospective trials are warranted to identify and stratify the at-risk population with extensive preprocedural evaluation and determine ways to mitigate the sex-related disparities in clinical outcomes following the LAAO procedure.
Leadless vs. Conventional Transvenous Pacemakers in Valve Intervention Patients: A Systematic Review & Meta-Analysis.
Gad AS, Eissa OA, Awad L … +3 more , Elkhouly A, Altaamreh SM, Saeed TZ
Pacing Clin Electrophysiol · 2026 Apr · PMID 41631635 · Publisher ↗
BACKGROUND: Management of structural heart diseases (SHD) with either transcatheter or surgical valve interventions has led to a growing number of patients requiring post-procedural permanent pacemaker implantation,(PPI)...
BACKGROUND: Management of structural heart diseases (SHD) with either transcatheter or surgical valve interventions has led to a growing number of patients requiring post-procedural permanent pacemaker implantation,(PPI) with rates of implantation reaching as high as 37.7% after transcatheter aortic valve replacement (TAVR). Transvenous pacemakers (TVP) have been the standard of care for such cases, although they carry the risk of numerous complications, such as surgical pocket and lead infections. Leadless pacemakers (LP) were introduced as an alternative to minimize these risks. This study aims to compare the outcomes of leadless versus TVP implantation in patients undergoing valve intervention during the peri-procedural duration. METHODS: We conducted a systematic review and meta-analysis of studies identified through a comprehensive search of the PubMed, Scopus, Web of Science, and Cochrane Library databases, performed in accordance with the Cochrane Handbook, to compare leadless and TVP in valve intervention patients during the peri-procedural period. Data analysis was performed using Comprehensive Meta-analysis (CMA, version 3.7.107). Primary outcomes included mortality, rehospitalization, and device- or procedure-related complications. Risk ratios (RRs) and mean differences (MDs) were calculated for dichotomous and continuous outcomes, respectively, both with 95% confidence intervals (CIs). The protocol was prospectively registered (PROSPERO: CRD420251150891). RESULTS: The meta-analysis included 5 cohort studies comprising 10,494 participants. 794 patients received LP and 9,700 received conventional TVP. LP patients had a significantly higher mortality risk (RR = 1.85; 95% CI, 1.06-3.20; p = 0.029), longer hospital stay (MD = 0.67; 95% CI, 0.43-0.90; p < 0.001) and lower ventricular pacing burden (MD = -11.39; 95% CI, -18.98 to -3.80; p = 0.003) compared to patients with conventional TVP. There was no statistically significant difference between the two groups regarding rehospitalization, pocket infection, lead/device dislodgement, and vascular complications. CONCLUSION: In this meta-analysis, LP implantation was associated with reduced ventricular pacing burden, but at the expense of a longer hospital stay and increased mortality risk compared with conventional TVP. No significant differences were observed between the two modalities in terms of rehospitalization, pocket infection, lead/device dislodgement, and vascular complications. These findings suggest that although LP were associated with higher observed mortality, this association is likely driven by selection bias, as leadless devices are preferentially implanted in patients with higher baseline risk and greater comorbidity burden. Randomized controlled trials are needed to clarify the comparative safety of leadless versus TVP while minimizing confounding by indication. TRIAL REGISTRATION: The study protocol was prospectively registered in PROSPERO (CRD420251150891).
Difficulty and Complications of Lead Extraction-Is ICD Lead Design Important?
Kutarski A, Jacheć W, Stefańczyk P … +2 more , Tułecki Ł, Nowosielecka D
Pacing Clin Electrophysiol · 2026 May · PMID 41631601 · Publisher ↗
BACKGROUND: Transvenous removal of implantable cardioverter-defibrillator (ICD) leads is considered to be more difficult and risky. The goal was to explore the impact of ICD lead design on transvenous lead extraction (TL...
BACKGROUND: Transvenous removal of implantable cardioverter-defibrillator (ICD) leads is considered to be more difficult and risky. The goal was to explore the impact of ICD lead design on transvenous lead extraction (TLE) safety and effectiveness. METHODS: Analysis of 3929 TLE procedures (including 1068 with ICD lead extraction) were analyzed retrospectively. RESULTS: The extracted ICD leads were about three years younger than pacemaker (PM) leads (medians: 61.00 vs. 97.00 months). The rate of major TLE complications (MC) was significantly higher in the PM lead extraction group (2.25% vs. 0.75%; p = 0.002) and complete procedural success was achieved significantly less often (by 4.11%; p < 0.001 in entire group of patients and by 3.74%; p < 0.001 in patients matched according to age of extracted lead). However, no significant differences were found in the scores of TLE complexity and major complications during extraction of ICD leads produced by different manufacturers. Lower rates of complete procedural success, compared to Medtronic ICD leads, were found in patients with Abbott and Biotronik ICD leads (99.45% vs. 97.32%; p = 0.009 and 96.65%; p = 0.003). CONCLUSIONS: 1. ICD lead implant duration was 3.17 years shorter and perhaps for this reason ICD lead extraction was often less difficult, the procedure less complex and MC significantly rare (0.75%) in comparison with PM lead extraction (2.55%). There were no differences between groups matched according to age of extracted lead. Achieving of complete procedural success was lower in PM lead extraction both in entire as in matched group of patients. 2. There were no significant differences in the complexity of TLE procedures or the incidence of major complications depending on ICD lead manufacturer, despite the fact that Biotronik leads were 16-19 months older. 3. The extraction of Abbot and Biotronik leads was associated with a lower rate of complete procedural success (by 2.13% and 2.80%).
When Substrate Meets Device: ICD Implantation and Therapy across the Spectrum of Cardiomyopathies.
Sisti N, Cardona A, Lazzari L … +5 more , Fortuni F, Santoro A, Andreoli C, Notaristefano F, Carreras G
Pacing Clin Electrophysiol · 2026 Apr · PMID 41631597 · Publisher ↗
INTRODUCTION: Implantable cardioverter-defibrillators (ICDs) are the cornerstone of sudden cardiac death prevention in cardiomyopathies, but disease-specific structural and electrophysiological substrates profoundly affe...
INTRODUCTION: Implantable cardioverter-defibrillators (ICDs) are the cornerstone of sudden cardiac death prevention in cardiomyopathies, but disease-specific structural and electrophysiological substrates profoundly affect device performance and outcomes. Understanding these distinctions is critical for tailoring therapy and improving patient safety. AREAS COVERED: This review examines current evidence and practical experience regarding ICD implantation, programming, and management in hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and cardiac amyloidosis (CA). We performed a structured narrative synthesis to identify phenotype-specific technical challenges, programming strategies, and complication trends. For HCM, lead placement and programming to minimize inappropriate therapies are emphasized; for ARVC, issues of lead instability, oversensing, and ATP efficacy are explored; and for CA, defibrillation thresholds, sensing difficulties, and individualized indications are discussed. EXPERT OPINION: ICD therapy in cardiomyopathies must be individualized, balancing arrhythmic protection against disease-specific risks and device-related complications. Tailored programming, careful system selection, and remote monitoring are key to improving outcomes. Emerging technologies such as modular and extravascular ICD systems promise safer and more phenotype-driven care.
Distinct Automaticity and Excitability Between Radiofrequency and Cryoballoon Ablation in Paroxysmal Atrial Fibrillation.
Jiang X, Zhao G, Jiang Q … +10 more , Ju W, Yang G, Li M, Gu K, Wang Z, Liu H, Cui C, Cai C, Chen H, Chen M
Pacing Clin Electrophysiol · 2026 May · PMID 41582877 · Publisher ↗
BACKGROUND: Cryoballoon ablation (CBA) has been shown as an effective alternative strategy to radiofrequency ablation (RFA) for the treatment of paroxysmal atrial fibrillation (PAF), with comparable efficacy and safety....
BACKGROUND: Cryoballoon ablation (CBA) has been shown as an effective alternative strategy to radiofrequency ablation (RFA) for the treatment of paroxysmal atrial fibrillation (PAF), with comparable efficacy and safety. However, the electrophysiological properties in pulmonary veins (PVs) after CBA and RFA are not well understood. This study compares these characteristics in PAF patients. METHODS: Consecutive patients with PAF undergoing initial catheter ablation were prospectively randomized to CBA (N = 50) or RFA (N = 50) for PV isolation (PVI). Each PV's automaticity and excitability were assessed. Follow-up for atrial tachyarrhythmia recurrence at 3, 6, and 12 months was monitored via electrocardiogram/Holter. RESULTS: A total of 100 patients were randomized (mean age of 62 ± 10 years). After initial PVI, 33 (66%) patients in the RFA group retained PV automaticity, compared to 17 (34%) patients in the CBA group (p = 0.027). The number of PVs exhibiting stable automaticity was significantly higher in the RFA group compared with the CBA group (51/198 vs. 19/197, p < 0.0001). Ipsilateral PV crosstalk was more common in the RFA group (7/17 vs. 0/2, p = 0.5088). Moreover, low-frequency pacing revealed local capture in 46% of the RFA group versus 2% of the CBA group (p < 0.0001). Fluoroscopy time was shorter with RFA (p = 0.0003), but ablation time was longer (p < 0.0001). Over an average of 13-month follow-up, atrial tachyarrhythmia recurrence rates were similar between groups. CONCLUSIONS: Automaticity and excitability within PVs were more prevalent in the RFA group than the CBA group after AF ablation.
Association of Neighborhood Income With In-Hospital Outcomes After Leadless Pacemaker Implantation: A National Analysis.
Sagoo NS, Sagoo R, Haider AS … +3 more , Kharbat Y, Charate R, Manyam H
Pacing Clin Electrophysiol · 2026 Apr · PMID 41582873 · Publisher ↗
BACKGROUND: Leadless pacemakers (LPMs) avoid transvenous leads and subcutaneous pockets and can reduce lead- and pocket-related complications. Whether neighborhood income relates to in-hospital outcomes after LPM implant...
BACKGROUND: Leadless pacemakers (LPMs) avoid transvenous leads and subcutaneous pockets and can reduce lead- and pocket-related complications. Whether neighborhood income relates to in-hospital outcomes after LPM implantation is not well characterized. OBJECTIVE: To evaluate the association between ZIP-code-based median household income and in-hospital outcomes after LPM implantation in the United States. METHODS: Using the National Inpatient Sample (2018-2022), we identified adult LPM implantations and applied discharge weights to estimate national totals. Admissions were stratified by income quartile (Q1 lowest to Q4 highest). Multivariable logistic regression estimated adjusted odds ratios (aORs) for in-hospital mortality, pericardial complications, bleeding, transfusion, venous thromboembolism, renal complications, and device removal or revision, adjusting for demographics, comorbidities, payer, and hospital region. RESULTS: We identified 41,985 weighted admissions (8397 unweighted). Q1 patients were younger (median 77.0 vs. 81.0 years; p < 0.001) and had more diabetes (44.9% vs. 33.8%) and end-stage renal disease (43.4% vs. 36.6%). Crude mortality was highest in Q1 (4.7%). After adjustment, Q2 had higher odds of in-hospital death versus Q1 (aOR 1.517; 95% confidence interval [CI], 1.115 to 2.064; p = 0.008). Pericardial complications increased with income (Q1 3.2% vs. Q4 4.1%); Q4 had higher adjusted odds versus Q1 (aOR 1.753; 95% CI, 1.244 to 2.469; p = 0.001). Q4 had lower adjusted odds of bleeding (aOR 0.788; 95% CI, 0.633 to 0.982; p = 0.034) and transfusion (aOR 0.645; 95% CI, 0.494 to 0.842; p = 0.001). Venous thromboembolism was more likely in Q2 and Q4 versus Q1. Median hospital charges (billed amounts) were highest in Q4, while median length of stay was longer in Q1 (6.0 vs. 5.0 days; p < 0.001). CONCLUSIONS: Neighborhood income showed endpoint-specific associations with in-hospital outcomes after LPM implantation. These patterns may inform peri-procedural counseling and institutional review.
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