BACKGROUND: The diagnostic performance of CARTO FINDER system for repetitive focal activations (FAs) that may sustain atrial fibrillation (AF) remains under debate. METHODS: In this prospective singlecenter study, we eva...BACKGROUND: The diagnostic performance of CARTO FINDER system for repetitive focal activations (FAs) that may sustain atrial fibrillation (AF) remains under debate. METHODS: In this prospective singlecenter study, we evaluated FAs detected by the mapping system during contralateral atrial burst pacing (CLABP) in sinus rhythm (SR) and during AF to characterize their features and potential underlying mechanisms. Protocol 1: The left atrium (LA) and right atrium (RA) were sequentially mapped during CLABP, delivered from the right atrial appendage (RAA) during LA mapping and from the left atrial appendage (LAA) during RA mapping. Protocol 2: Both atria were mapped in AF, and FA sites were partially remapped during CLABP after SR restoration to assess overlap. Mean cycle length (mCL) and its standard deviation (CL-Std) during AF were compared between overlapping and non-overlapping sites. RESULTS: In Protocol 1, FAs were detected in LA roof/LA septum/LAA/RAA (100%), anterior LA/RA septum (92%), and posterior LA/lateral RA (83%). In Protocol 2, detection sites included lateral LA/LAA/lateral RA/posterior RA/RA septum/RAA (100%), inferior LA (89%), and posterior LA (78%). During CLABP and AF, FAs were frequently and similarly detected in LAA/RAA, septal regions, posterior LA/inferior LA, and lateral RA. Although overlapping sites showed longer mCL (169.8 ± 15.1 vs. 161.8 ± 12.7 ms; p = 0.002) and higher CL-Std (20.1 ± 7.8 vs. 17.1 ± 5.0 ms; p = 0.02), neither predicted overlap. CONCLUSIONS: A substantial portion of FAs detected by the mapping system may arise from complex activation pathways rather than focal sources, delineating interpretive gaps and outlining targets for subsequent refinement.
Functional bradycardia, characterized by a heart rate below the normal range due to dysregulation of the autonomic nervous system (ANS), poses a clinical challenge with limited treatment options. Symptomatic sinus bradyc...Functional bradycardia, characterized by a heart rate below the normal range due to dysregulation of the autonomic nervous system (ANS), poses a clinical challenge with limited treatment options. Symptomatic sinus bradycardia is an uncommon but potentially significant complication following bariatric surgery. Cardioneuroablation (CNA) has emerged as a novel therapeutic intervention targeting the cardiac ANS to modulate heart rate. This case series describes two patients, with the aim of providing a simplified but successful approach with targeted partial CNA for sinus bradycardia complicating bariatric surgery.
BACKGROUND: Electrical cardioversion (ECV) is a commonly performed procedure for rhythm control in patients with atrial fibrillation (AF); however, approximately 10%-15% of procedures are unsuccessful. Although several c...BACKGROUND: Electrical cardioversion (ECV) is a commonly performed procedure for rhythm control in patients with atrial fibrillation (AF); however, approximately 10%-15% of procedures are unsuccessful. Although several clinical and echocardiographic predictors of ECV success have been identified, the impact of the Body Roundness Index (BRI) on ECV outcomes has not yet been clearly established. In this study, we aimed to investigate the effect of BRI on post-procedural ECV success in patients undergoing cryoballoon ablation for persistent AF. METHODS: This retrospective study included patients who underwent cryoballoon ablation for persistent AF between January 2024 and December 2025 at the Electrophysiology Unit of the Cardiology Department, Etlik City Hospital, Ministry of Health of the Republic of Türkiye. Following cryoballoon ablation, electrical cardioversion was performed to restore sinus rhythm. Patients were divided into two groups according to cardioversion outcome: successful and unsuccessful ECV. A total of 419 patients were screened; 160 patients with paroxysmal AF and 10 patients with incomplete anthropometric or echocardiographic data were excluded. Ultimately, 249 patients were included in the final analysis. RESULTS: Among the 249 patients included in the study, sinus rhythm was successfully restored in 201 patients (80.7%) following the standard ECV protocol, whereas ECV failed in 48 patients (19.3%). Patients in the unsuccessful ECV group had significantly higher BRI values compared with those in the successful group (6.23 ± 1.17 vs. 4.08 ± 0.73, p < 0.001). Similarly, body mass index (BMI) was also significantly higher in the unsuccessful group (30.95 ± 3.45 vs. 29.16 ± 3.39, p = 0.001). In addition, patients with unsuccessful ECV had larger left atrial diameter (48.88 ± 5.10 mm vs. 42.31 ± 4.65 mm, p < 0.001) and lower ejection fraction values (49.33 ± 13.38% vs. 54.60 ± 9.34%, p = 0.002). In multivariable logistic regression analysis, BRI emerged as a strong and independent predictor of ECV failure (OR = 29.363, 95% CI: 8.102-106.423, p < 0.001). Receiver operating characteristic (ROC) curve analysis demonstrated that BRI had superior discriminative performance compared with BMI in predicting ECV failure (AUC = 0.972, 95% CI: 0.952-0.992). The optimal BRI cutoff value for predicting ECV failure was 4.94, with a sensitivity of 93.8% and specificity of 89.5%. In contrast, the BMI cutoff value was 30.95 kg/m, yielding a sensitivity of 45.8% and specificity of 77%. CONCLUSION: Body Roundness Index appears to be a stronger anthropometric predictor than BMI for predicting electrical cardioversion failure in patients with persistent atrial fibrillation.
BACKGROUND: Cardiac implantable electronic device (CIED) implants are frequently associated with peri- and post-operative pain. Pectoral nerve block (PECS), initially described for breast surgeries, has increasingly been...BACKGROUND: Cardiac implantable electronic device (CIED) implants are frequently associated with peri- and post-operative pain. Pectoral nerve block (PECS), initially described for breast surgeries, has increasingly been used in other chest surgeries to alleviate pain, including CIED implants. This systematic review and meta-analysis aimed to estimate the efficacy and safety of the PECS block in pain management of patients undergoing CIED implant. METHODS: The Medline (PubMed) and Scopus databases were searched from their inception until May 31, 2025. Randomized controlled trials and observational studies that reported on the PECS block for pain control during CIED implants were included. (PROSPERO CRD420251071794) RESULTS: After exclusion, five eligible studies (n = 816) were included in the meta-analysis. The studies reported low mean pain scores at 1 h, 6 h, and 24 h after CIED implants (1.74±0.65, 0.98±0.12, and 1.06 ± 0.93, respectively). A single study reported statistically lower pain scores with PECS block compared to standard care at four hours (1.5 ± 2.1 vs. 4.5 ± 2.5, p < 0.001). No PECS-related complications were reported in the included studies. PECS was associated with low intra- and post-operative opioid requirement (12.17%, 95% CI 7.7-17.49; I 5.94% and 9.95%, 95% CI 7.52-12.68; I 0.00%, respectively). CONCLUSIONS: Available observational evidence suggests that the PECS block is associated with low pain scores, reduced opioid requirements, and high patient satisfaction after CIED implant. However, the evidence remains limited by the lack of robust comparative and randomized data. TRIAL REGISTRATION: CRD420251071794.
BACKGROUND: Transcatheter retrieval of a dislodged leadless pacemaker (LP) from a tricuspid valve-in-valve (ViV) prosthesis has not been previously reported. CASE SUMMARY: A 42-year-old woman with a prior bioprosthetic t...BACKGROUND: Transcatheter retrieval of a dislodged leadless pacemaker (LP) from a tricuspid valve-in-valve (ViV) prosthesis has not been previously reported. CASE SUMMARY: A 42-year-old woman with a prior bioprosthetic tricuspid valve, transvenous pacemaker, and subsequent percutaneous ViV implantation presented with ventricular lead dysfunction. A Micra LP was implanted but dislodged within 7 days. The device was retrieved using a sheath-in-sheath system combined with a double-snare technique under fluoroscopic guidance. The first snare engaged the device, and traction induced tine deformation and device mobilization. After retraction into the right atrium, a second snare enabled coaxial alignment for safe retrieval into the introducer sheath. A new LP was immediately reimplanted with stable electrical parameters that remained satisfactory at 1-year follow-up. No prosthetic valve injury or thromboembolic complications occurred. CONCLUSION: This case demonstrates that transcatheter retrieval and same-day reimplantation of LP via a tricuspid ViV prosthesis is feasible and safe.
INTRODUCTION: The ablation of septal accessory pathways (APs) in pediatric patients presents significant challenges owing to the close proximity of the atrioventricular (AV) node. Our objective was to assess the influenc...INTRODUCTION: The ablation of septal accessory pathways (APs) in pediatric patients presents significant challenges owing to the close proximity of the atrioventricular (AV) node. Our objective was to assess the influence of contact force (CF)-sensing technology combined with a "conservative force" strategy on procedural efficiency and safety within this high-risk demographic. METHODS: We retrospectively analyzed 157 pediatric patients who underwent radiofrequency (RF) ablation for septal APs (anteroseptal, midseptal, or posteroseptal). Patients were divided into two groups: the CF group (n = 77), utilizing a target force of 5-12 g, and the non-CF group (n = 80), using conventional irrigated catheters. RESULTS: The CF group achieved significantly shorter total procedure times (65.0 vs. 80.0 min; p = 0.029) and reduced total RF application times (78.0 vs. 105.0 s; p = 0.047) compared to the non-CF group. In the CF group, the median CF was 10.0 g, and the median RF power was significantly lower than in the non-CF group (25 W vs. 30 W; p = 0.003). Subgroup analysis revealed a significant gain in efficiency for posteroseptal (PS) pathways , whereas anteroseptal (AS) pathways required longer procedure times in the CF era due to safety-driven force titration (105.0 vs. 70.0 min; p = 0.012). Acute success rates (98.7% vs. 93.8%; p = 0.210) and recurrence rates (5.2% vs. 11.3%; p = 0.277) were comparable between the groups. No permanent AV block or major complications occurred in either cohort. CONCLUSION: Integrating CF technology with a conservative force strategy (5-12 g) enhances procedural efficiency in pediatric septal AP ablation without compromising safety. While it streamlines the workflow for most septal locations, the AS region requires more meticulous titration, and the midseptal (MS) region remains the most prone to recurrence.
BACKGROUND: Low-voltage areas (LVAs) detected via electroanatomic mapping (EAM) are key indicators of atrial remodeling and predictors of atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI). Howe...BACKGROUND: Low-voltage areas (LVAs) detected via electroanatomic mapping (EAM) are key indicators of atrial remodeling and predictors of atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI). However, manual LVA quantification is time-intensive, operator-dependent, and prone to variability. OBJECTIVE: To validate the accuracy, consistency, and efficiency of automatic LVA quantification function of CARTONET-a cloud-based automated platform for LVA quantification-by comparing it with conventional manual analysis in AF patients. METHODS: This retrospective study included 100 patients who underwent PVI for AF at a single center between January 2022 and December 2023. Manual LVA measurements were performed by experts using CARTO3. LVA quantification and anatomical segmentation were performed using CARTONET. LVA was stratified into four categories: low (<5%), mild (5%-20%), moderate (20%-35%), and severe (>35%). Statistical analyses included Spearman's rank correlation (ρ), Bland-Altman agreement, and confusion matrices for categorical classification, with subgroup analysis based on segmentation errors and map point density. The number and the locations of segmentation errors were quantified. RESULTS: CARTONET demonstrated strong correlation with manual measurements across all LA regions (ρ = 0.928-0.983, p < 0.01). Significant differences were observed in anterior and posterior walls (p < 0.01), especially in low-density maps. In high-density maps, no significant differences were observed (p ≥ 0.07). Bland-Altman analysis showed minimal bias (mean difference: -0.8%), and 96% of values fell within limits of agreement. The confusion matrix showed that categorical agreement for LVA stratification exceeded 90%. Segmentation errors were most common at the LSPV but did not significantly impact LVA quantification. CONCLUSION: CARTONET offers reliable, efficient LVA quantification with high concordance to manual methods. Its performance in high-quality maps supports its use in clinical and research settings, reducing operator workload and promoting standardized substrate evaluation.
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been associated with reduced atrial fibrillation (AF) recurrence after catheter ablation in obese and diabetic populations, largely attributed to wei...BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been associated with reduced atrial fibrillation (AF) recurrence after catheter ablation in obese and diabetic populations, largely attributed to weight reduction. Whether these agents provide weight-independent antiarrhythmic benefits remains unclear. We evaluated the association between GLP-1 RA therapy and long-term clinical outcomes following AF ablation in non-obese patients. METHODS: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network. Adults (≥18 years) with body mass index (BMI) ≤29.9 kg/m who underwent AF ablation between 2010 and 2025 were identified. Patients receiving GLP-1 RAs within 6 months of ablation were compared with non-users. Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory variables. Outcomes were assessed at 1 and 3 years following a 3-month blanking period. Primary endpoints included atrial flutter, cardioversion, repeat ablation, and antiarrhythmic drug (AAD) use. Secondary outcomes included heart failure exacerbation, all-cause hospitalization, stroke, and mortality. RESULTS: After matching, 1749 patients were included in each group (mean age 68 years; 38% female). At 1 year, GLP-1 RA use was associated with lower cardioversion (hazard ratio [HR] 0.61; 95% confidence interval [CI] 0.40-0.91), reduced AAD use (HR 0.68; 95% CI 0.61-0.77), decreased heart failure exacerbation (HR 0.53; 95% CI 0.32-0.85), and fewer hospitalizations (HR 0.69; 95% CI 0.51-0.94). Repeat ablation, stroke, and mortality were similar. At 3 years, reductions in cardioversion, AAD use, and heart failure exacerbation persisted. CONCLUSIONS: In non-obese patients undergoing AF ablation, GLP-1 RA therapy was associated with reduced arrhythmia-related interventions and heart failure exacerbation, supporting potential weight-independent antiarrhythmic effects. Prospective trials are warranted.
BACKGROUND: Previous studies have demonstrated electrical connections between ipsilateral pulmonary veins (PVs). This study aimed to characterize the electrophysiological features of right middle pulmonary vein (RMPV) or...BACKGROUND: Previous studies have demonstrated electrical connections between ipsilateral pulmonary veins (PVs). This study aimed to characterize the electrophysiological features of right middle pulmonary vein (RMPV) originating from right superior pulmonary vein (RSPV). METHODS: We prospectively enrolled patients with atrial fibrillation (AF) with an identifiable RMPV on pre-procedural cardiac computed tomography angiography (CTA) and in whom a multipolar mapping catheter could be advanced into the RMPV. Cardiac CTA was used to assess left atrial and PV anatomy, including ostial diameter, area and ovality index. The RMPV was defined as an inferiorly directed branch arising from the ostium-proximal segment of the RSPV, within 1 cm from the ostium RESULTS: A total of 118 patients were included (mean age 63.9 years, 63.6% male). The mean RMPV ostial area was 0.69 ± 0.41 cm, with maximum and minimum diameters of 0.83 ± 0.21 cm and 0.63 ± 0.17 cm, respectively. The mean ovality index was 1.35 ± 0.27 for RMPV. AF triggers originating from the RMPV were identified in 3 patients (2.5%). During circumferential pulmonary vein isolation (CPVI), RMPV potentials were eliminated in 99 patients (83.9%), concurrently with disappearance of RSPV potentials. In the remaining 19 patients, RMPV potentials persisted after CPVI and required additional carina ablation to achieve isolation. After a mean follow-up of 41 months, 96 patients remained free from atrial tachyarrhythmia recurrence after the index procedure. CONCLUSIONS: RMPV potentials predominantly originate from the RSPV and can usually be eliminated during CPVI. However, additional carina ablation is required in a subset of patients to achieve RMPV isolation.
OBJECTIVE: Although coffee consumption is often reported as a trigger for atrial fibrillation (AF), prospective studies on the association between coffee consumption and AF risk have been inconsistent. Hence, we sought t...OBJECTIVE: Although coffee consumption is often reported as a trigger for atrial fibrillation (AF), prospective studies on the association between coffee consumption and AF risk have been inconsistent. Hence, we sought to assess the association between coffee consumption and risk of AF. METHODS: We searched PubMed, Embase, and Cochrane Library up to November 30, 2025, without language restriction. We included cohort or nested case-control studies that enrolled participants with no AF history who did not drink coffee or had daily coffee consumption. The outcome was the risk of new-onset AF in participants with coffee consumption. RESULTS: Overall, 9 observational cohorts were selected for this meta-analysis, comprising 704,121 individuals and 35,253 new-onset AF cases. The subgroup analysis showed a reduced new-onset AF risk among participants who drank coffee for less than or equal to 1 cup daily (RR: 0.96; 95%CI: 0.93-0.99), but no significant association with new-onset AF risk among those who drank 1-3 cups/d (RR: 0.95; 95%CI: 0.85-1.06), 3-5 cups/d (RR: 0.96; 95%CI: 0.91-1.02), ≥4 cups/d (RR: 0.89; 95%CI: 0.78-1.02), or ≥5 cups/d (RR: 0.93; 95%CI: 0.86-1.02). Compared with the lowest level of coffee intake, the overall estimate of the highest coffee consumption in the included studies also showed that ≥4 cups/d were not significantly associated with reduced risk of new-onset AF (RR: 0.95; 95% CI: 0.89-1.02). In addition, this result was consistent across men (RR: 1.05; 95% CI: 0.97-1.14) and women (RR: 0.91; 95% CI: 0.80-1.04). CONCLUSION: Daily coffee consumption of 1 cup or less can reduce the risk of new-onset AF. However, higher coffee consumption is not associated with the risk of new-onset AF.
AIM: This study aimed to evaluate the intraoperative and postoperative analgesic effectiveness of ultrasound-guided clavipectoral fascial plane block in patients undergoing cardiac implantable electronic device (CIED) im...AIM: This study aimed to evaluate the intraoperative and postoperative analgesic effectiveness of ultrasound-guided clavipectoral fascial plane block in patients undergoing cardiac implantable electronic device (CIED) implantation. METHODS: In this prospective observational study, 35 adult patients scheduled for CIED implantation received an ultrasound-guided clavipectoral fascial plane block. Intraoperative analgesic adequacy was assessed by the requirement for supplemental local anesthetic. Additional intraoperative fentanyl use, block performance time, and surgical duration were recorded. Postoperative pain was evaluated using the numerical rating scale (NRS) at 1, 6, 12, and 24 h. Postoperative analgesic consumption and patient satisfaction, assessed using a 5-point Likert scale, were also documented. RESULTS: Supplemental local anesthetic was required in 16 patients (45.7%), while 19 patients (54.3%) completed the procedure without additional local anesthetic. Among patients requiring supplementation, the median volume of local anesthetic administered was 6 mL (IQR 6-10). Intraoperative fentanyl was administered in seven patients (20.0%). Median block performance time was 6 min (IQR 5-8), and median surgical duration was 39 min (IQR 33-43). Postoperative pain scores remained low over 24 h. Rescue tramadol was required in 11 patients (31.4%), with a median consumption of 0 mg (IQR 0-50). Patient satisfaction was high, with 71.4% of patients reporting satisfaction or high satisfaction. CONCLUSION: Clavipectoral fascial plane block appears to provide clinically relevant intraoperative and postoperative analgesia in patients undergoing CIED implantation, with low opioid requirements and high patient satisfaction. This technique may represent a practical component of multimodal analgesia for CIED procedures. Further randomized studies are needed to confirm these findings.
Immune checkpoint inhibitors (ICIs) are now standard of care for most advanced solid tumors. While effective, they are associated with immune-related adverse events (irAEs), including rare autonomic complications. We pre...Immune checkpoint inhibitors (ICIs) are now standard of care for most advanced solid tumors. While effective, they are associated with immune-related adverse events (irAEs), including rare autonomic complications. We present a patient with metastatic lung adenocarcinoma receiving nivolumab and ipilimumab who developed reflex syncope with reproducible complete heart block (CHB) triggered by swallowing and food proximity. Barium esophagram revealed esophageal dysmotility, a small hiatal hernia, and distal esophageal narrowing. ICI therapy was held, and a dual-chamber pacemaker resolved the syncopal episodes. The overlap between structural esophageal pathology, possible ICI-associated autonomic dysregulation, and situational syncope complicates diagnosis and management. Clinicians should maintain vigilance for autonomic manifestations, especially new-onset bradyarrhythmias or syncope, in patients on immunotherapy.
We report a 14-year-old female with a history of surgically corrected Ebstein anomaly, including a bidirectional Glenn shunt and atrial septostomy. Following a bioprosthetic tricuspid valve replacement, the patient devel...We report a 14-year-old female with a history of surgically corrected Ebstein anomaly, including a bidirectional Glenn shunt and atrial septostomy. Following a bioprosthetic tricuspid valve replacement, the patient developed complete atrioventricular block and became pacemaker-dependent. A unique transvenous approach was utilized: the ventricular lead was advanced from the left axillary vein through the left subclavian vein, superior vena cava, right pulmonary artery, and main pulmonary artery into the right ventricle, resulting in successful left bundle branch pacing. This case illustrates an innovative strategy for permanent physiological pacing in post-Glenn patients.
The coexistence of dextrocardia and Wolff-Parkinson-White (WPW) syndrome is exceedingly rare and presents unique challenges for electrophysiological mapping and ablation. We report the first successful radiofrequency cat...The coexistence of dextrocardia and Wolff-Parkinson-White (WPW) syndrome is exceedingly rare and presents unique challenges for electrophysiological mapping and ablation. We report the first successful radiofrequency catheter ablation guided by three-dimensional open-window mapping (OWM) in such a patient. Pre-procedural right-sided electrocardiography analyzed with the EASY-WPW algorithm predicted a right inferoparaseptal accessory pathway, consistent with OWM localization. Despite reversed cardiac anatomy, precise mapping enabled effective ablation without complications. This case illustrates the feasibility of three-dimensional OWM-guided ablation in complex anatomic variants and highlights the complementary role of the EASY-WPW algorithm in accurately predicting accessory pathway locations before intervention.
Onuki K, Hirokami J, Chinen H
… +12 more, Nagai H, Oyanagi N, Misonou K, Kuroda M, Kono H, Katsuki T, Kuji R, Korai K, Fukunaga M, Nagashima M, Hiroshima K, Ando K
Pulsed-field ablation (PFA) in patients with an implanted extravascular implantable cardioverter-defibrillator (EV-ICD) poses theoretical risks of electromagnetic interference or lead displacement. We report two cases of...Pulsed-field ablation (PFA) in patients with an implanted extravascular implantable cardioverter-defibrillator (EV-ICD) poses theoretical risks of electromagnetic interference or lead displacement. We report two cases of atrial fibrillation (AF) ablation using the FARAPULSE pentaspline catheter after EV-ICD implantation. In both patients, PFA was successfully performed without significant changes of the parameters/functions of the EV-ICDs. No lead dislodgement was observed on a fluoroscopy examination. These cases suggest that AF ablation using PFA can be safely performed in patients with EV-ICDs.
INTRODUCTION: Clinical guidelines do not recommend the routine rinsing of cardiac implantable electronic devices (CIED) with antimicrobials before pocket closure("antimicrobial pocket flush.") However, despite current re...INTRODUCTION: Clinical guidelines do not recommend the routine rinsing of cardiac implantable electronic devices (CIED) with antimicrobials before pocket closure("antimicrobial pocket flush.") However, despite current recommendations and a lack of evidence regarding the utility of this practice for reducing CIED infections, the antimicrobial pocket flush is still commonly employed. Clarifying the true value of this technique is important for supporting evidence-based practice and avoiding unnecessary antimicrobial use. Therefore, we performed meta-analysis of observational studies to determine the effectiveness of this practice in preventing CIED infections. METHODS: We performed a systematic literature search for observational human studies investigating the effectiveness of employing the antimicrobial pocket flush to prevent CIED infection. A random effects meta-analysis was performed. Effectiveness was estimated with the study-level definitions of CIED infection. We performed subgroup analysis by type of antimicrobial-antiseptic or antibiotic. RESULTS: A total of seven studies including 12,283 patients were analyzed. Over half of the CIED implantation procedures (61.5%) included the antimicrobial pocket flush, and between 8.4% and 85% of the implantations were revision procedures. Studies used various antimicrobials for pocket flush, and definitions of CIED infection varied. Overall infection rates ranged from 0.5%-1.5%. CIED infection rates did not differ significantly between procedures performed with versus without antimicrobial pocket flush (0.8% vs. 1.1%; relative risk 0.80; 95% confidence interval 0.39-1.63; p = 0.54). There was no difference in the subgroup analysis by antiseptic or antibiotic use. CONCLUSION: Our results suggest that the antimicrobial pocket flush provides no benefit in preventing CIED infection, reinforcing the current guidelines that do not support its routine use.
BACKGROUND: Coronary artery (CA) injury from catheter ablation is an uncommon complication, but the risk is under-recognized. The risk for CA injury significantly increases when a CA is within 3 mm of the site of ablatio...BACKGROUND: Coronary artery (CA) injury from catheter ablation is an uncommon complication, but the risk is under-recognized. The risk for CA injury significantly increases when a CA is within 3 mm of the site of ablation, but CA imaging to assess for CA proximity to ablation sites is not commonly performed in children prior to ablation. OBJECTIVE: The aim of the study was to assess CA proximity to potential ablation sites. METHODS: A retrospective review of all coronary computed tomography angiograms (CTAs) in pediatric patients <18 years of age at Mayo Clinic from 2017 through 2023 was conducted. The proximity of CAs to potential ablation sites in the coronary sinus and the appendage bases were measured. RESULTS: Seventy-two CTAs in 67 patients >15 kg and <18 years old were included. Median age was 12 years, and median weight was 41 kg. In right dominant CA circulation, 23/36 (64%) had a CA within 3 mm of the coronary sinus. In left and co-dominant CA circulation, 26/26 (100%) had a CA within 3 mm of the coronary sinus. The right CA was within 3 mm of the appendage base in 49/69 (71%). The circumflex CA was within 3 mm of the appendage base in 50/68 (74%). CONCLUSION: Most pediatric patients have a CA ≤ 3 mm from potential ablation sites in the coronary sinus and base of the appendages. Precautions should be taken to avoid CA damage before performing catheter ablation in these areas.
BACKGROUND: Physiology-based electrocardiographic (ECG) criteria are used to assess left bundle branch area pacing (LBBAP), but the impact of lead implantation site on ECG parameters remains unclear. METHODS: We analyzed...BACKGROUND: Physiology-based electrocardiographic (ECG) criteria are used to assess left bundle branch area pacing (LBBAP), but the impact of lead implantation site on ECG parameters remains unclear. METHODS: We analyzed 212 patients who underwent successful LBBAP and classified them into high septum (HS, n = 49), mid septum (MS, n = 119), and low septum (LS, n = 44) groups according to the polarity of leads II and III. ECG parameters, including QRS morphology in lead V1, stimulus-to-R-wave peak times in V6 and V1 (sV6RWPT, sV1RWPT), and the V6-V1 interpeak interval, were compared. The proportions meeting proposed physiology-based ECG criteria for left bundle branch (LBB) capture were also evaluated. RESULTS: The LS group demonstrated the highest prevalence of dominant R waves in V1 (qR: 38.6%, R: 4.5%, p < 0.01). It had a shorter sV6RWPT than the MS group (59 ± 9 ms, p = 0.011), with no significant difference compared with the HS group. It also demonstrated a longer sV1RWPT (105 ± 11 ms, p = 0.023) and V6-V1 interpeak interval (46 ± 10 ms, p < 0.01). Although no significant differences were observed among the three groups regarding output-dependent QRS transition or LBB potential, the LS group more frequently met the V6-V1 interpeak interval criterion (>44 ms, 86%, p < 0.01). CONCLUSIONS: In LBBAP, low septal lead placement was associated with prominent R waves in V1, shorter sV6RWPT versus the MS group, and longer V6-V1 interpeak intervals, highlighting the importance of implantation site when interpreting ECG findings.
Implantation of transvenous leads across a surgically treated tricuspid valve can worsen valve function and should be avoided when possible. We report a case in which a coronary sinus (CS) guiding catheter enabled the su...Implantation of transvenous leads across a surgically treated tricuspid valve can worsen valve function and should be avoided when possible. We report a case in which a coronary sinus (CS) guiding catheter enabled the successful implantation of an implantable cardioverter defibrillator (ICD) lead into the middle cardiac vein (MCV) in a patient with prior tricuspid valve surgery.