BACKGROUND: Postoperative arrhythmias are common after coronary artery bypass graft (CABG) surgery and are linked to adverse outcomes. Colchicine, an anti-inflammatory agent, has shown inconsistent results in prior studi...BACKGROUND: Postoperative arrhythmias are common after coronary artery bypass graft (CABG) surgery and are linked to adverse outcomes. Colchicine, an anti-inflammatory agent, has shown inconsistent results in prior studies, possibly due to dosing and timing variations. OBJECTIVES: To evaluate the efficacy and safety of short-term, weight-adjusted colchicine initiated preoperatively for preventing postoperative arrhythmias after CABG. METHODS: In this randomized, double-blind, placebo-controlled trial, 172 adults scheduled for on-pump CABG received colchicine or placebo. The regimen included a preoperative loading dose (1 mg twice daily) followed by a weight-based maintenance dose (0.5 mg daily if <70 kg; 1 mg daily if ≥70 kg) for 14 days. The primary outcome was incidence of postoperative atrial fibrillation (POAF). Secondary outcomes included early (≤48 h) and late (>48 h) POAF, other arrhythmias, inflammatory markers (CRP, ESR), length of stay, and adverse events. RESULTS: Of 163 analyzed patients (81 colchicine, 82 placebo), POAF incidence was significantly lower in the colchicine group (17.3% vs. 46.3%; RR 0.37, 95% CI 0.21-0.66; p < 0.001), with an absolute risk reduction of 29.0% and number needed to treat (NNT) of 4. Colchicine reduced both early and late POAF (p < 0.001 and p = 0.002). No significant reduction was seen in other arrhythmias. Gastrointestinal events, primarily diarrhea, were more common with colchicine (25.9% vs. 8.5%, p = 0.003), but were manageable and without serious adverse events. CONCLUSION: Short-term perioperative weight-adjusted colchicine is effective and safe for preventing POAF after CABG, with a low NNT and manageable side effects, though it did not significantly affect other arrhythmias. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20200328046886N6.
Catheter knotting is a rare but potentially serious complication encountered during electrophysiological procedures. We report an unusual case of catheter ablation for premature ventricular complexes (PVCs) arising from...Catheter knotting is a rare but potentially serious complication encountered during electrophysiological procedures. We report an unusual case of catheter ablation for premature ventricular complexes (PVCs) arising from anterolateral papillary muscle, where a ThermoCool SmartTouch (ST) catheter (Biosense Webster, Irvine, CA) developed a knot within the arterial system during transaortic mapping. The knot formed after the catheter was inadvertently withdrawn into the ascending aorta and re-advanced, leading to looping and tip entrapment. Standard maneuvers to untie the knot were unsuccessful. As a novel bailout strategy, the external portion of the catheter was cut near the handle and a large-bore 8.5 SL0 sheath (Swartz Braided SL Transseptal Guiding Introducer Sheath; length 63 cm) was advanced over it. The knotted catheter was then maneuvered against the aortic valve, and controlled mechanical contact led to successful loosening of knot and sheath retrieval. This case underscores the importance of early recognition, careful manipulation, and innovative problem-solving in managing rare mechanical complications in the cardiac electrophysiology lab.
BACKGROUND: The importance of managing tricuspid regurgitation (TR) has been increasingly recognized, and tricuspid valve replacement (TVR) is now performed more frequently. Conduction system pacing (CSP), including left...BACKGROUND: The importance of managing tricuspid regurgitation (TR) has been increasingly recognized, and tricuspid valve replacement (TVR) is now performed more frequently. Conduction system pacing (CSP), including left bundle branch area pacing (LBBAP), offers substantial benefits by improving left ventricular (LV) electrical synchrony. However, combining these two strategies is challenging. CASE: A 58-year-old man underwent dual-chamber pacemaker implantation for complete atrioventricular block. Five years later, he developed severe LV dysfunction due to right ventricular (RV) apical pacing-induced cardiomyopathy. Upgrade to conventional cardiac resynchronization therapy resulted in a persistently prolonged QRS duration (150 msec) and modest improvement in LV ejection fraction (LVEF, 35%). RV lead-related TR progressively worsened, leading to biventricular heart failure. Although tricuspid valve repair was performed, severe TR recurred. Following heart team discussion, both CSP upgrade and TVR were deemed necessary without delay. An LBBAP lead was implanted the day before surgery as an "electrophysiological anchor." During TVR, the lead was dislodged; however, the surgeon identified the insertion ("anchor") site, reinserted the lead, and secured it by jailing it outside the prosthetic valve in a protective position. Postoperatively, the pacing threshold improved (1.5 V@0.4 ms to 0.75V@0.4 ms) with QRS narrowing (135 to 125 ms). At three months, heart failure symptoms were markedly relieved, LVEF improved to 50%, and lead parameters remained stable. CONCLUSION: Although jailing a lead with a prosthetic valve requires great caution to ensure long-term lead survival, we successfully combined LBBAP and surgical TVR with intraoperative refixation.
BACKGROUND: Minimizing radiation exposure during electrophysiological studies remains an important priority in the catheterization laboratory. With the advancement of imaging and electroanatomic mapping systems, eliminat...BACKGROUND: Minimizing radiation exposure during electrophysiological studies remains an important priority in the catheterization laboratory. With the advancement of imaging and electroanatomic mapping systems, eliminating fluoroscopy from catheter ablation of arrhythmias is becoming more feasible, even for left side procedures requiring transseptal puncture. Nevertheless, there remain concern over the safety and efficacy of a zero-fluoroscopy approach. OBJECTIVES: The aim of this report was to evaluate the safety and efficacy of a zero-fluoroscopy catheter ablation approach for accessory pathways and atrioventricular nodal-reentrant tachycardia (AVNRT) in a diverse, consecutive patient cohort. METHODS: This was a retrospective analysis of all patients who underwent radiofrequency ablation or cryoablation of accessory pathways or AVNRT between January 2019 and June 2022 at a single institution. Patient demographics, arrhythmia substrates, ablation energy modalities, and procedural outcomes were evaluated. RESULTS: There were 166 total ablation procedures performed on 164 unique patients. Fluoroscopy was not used in any of the cases. The mean age was 14.8 years (range 3.1-35.7), of whom 84% were under 18 years of age. Among the 166 procedures performed, 58 involved only typical AVNRT, 1 atypical AVNRT, 99 were accessory pathways, and 8 involved multiple arrhythmia substrates. In all, there were 112 instances of accessory pathways (78 manifest, 34 concealed). Acute procedure success was 99.4%. There were five (5/164, 3%) recurrences after a year of follow-up. There were no complications identified. CONCLUSION: Zero-fluoroscopy approach to catheter ablation of AVNRT and accessory pathways is safe and effective, further supporting the general adoption of radiation-free techniques in such cases.
BACKGROUND: Nonvalvular atrial fibrillation (NVAF) patients with low CHA2DS2-VASc scores still have a risk of atrial thrombus formation. This study aims to identify these patients' risk factors for intracardiac thrombus...BACKGROUND: Nonvalvular atrial fibrillation (NVAF) patients with low CHA2DS2-VASc scores still have a risk of atrial thrombus formation. This study aims to identify these patients' risk factors for intracardiac thrombus or sludge. METHODS: We conducted a retrospective study of 919 consecutive hospitalized NVAF or atrial flutter patients with a CHA2DS2-Vas score ≤ 1 (male) and ≤ 2 (female) who underwent transesophageal echocardiogram (TEE) before catheter ablation at Beijing An Zhen Hospital from November 2016 to December 2017. We collected the clinical and echocardiographic characteristics of the patients. RESULTS: Excluding seven patients with hypertrophic cardiomyopathy, 919 patients, including 17 identified left atrial appendage (LAA) thrombus/sludge and 902 without LAA thrombus/sludge, were included. Among 17 patients with LAA thrombus/sludge, 16 (94.1%) had non-paroxysmal AF. A subgroup analysis was conducted in 403 non-paroxysmal atrial fibrillation (AF) patients. 87.8% had spontaneous echo contrast (SEC), 59.3% had severe or more severe SEC, and 4.0% had thrombus/sludge. In the multivariable model, female (odds ratio [OR] 4.612, 95% [CI] 1.454-14.627, p = 0.009) and LA diameter ≥ 45 mm (OR 13.340, [CI] 3.601, 49.415, p< 0.001) remained significantly independently associated with LAA thrombus/sludge. CONCLUSION: Among patients with NVAF and CHA2DS2-VASc scores ≤ 1 (male) and ≤ 2 (female), those non-paroxysmal AF patients who were female and had an LA ≥ 45 mm still had a risk of LAA thrombus/sludge formation.
Fluoroscopy has traditionally been the mainstay imaging technique for guidance during electrophysiology (EP) ablation procedures. The numerous disadvantages associated with radiation exposure for both operators and patie...Fluoroscopy has traditionally been the mainstay imaging technique for guidance during electrophysiology (EP) ablation procedures. The numerous disadvantages associated with radiation exposure for both operators and patients have created the need for zero-fluoroscopy (ZF) approaches. Today, electrophysiologists have access to a wide range of ZF tools, including electroanatomic mapping systems, transoesophageal and intracardiac echocardiography, visualisable sheaths, contact-force sensing catheters, preprocedural advanced cardiac imaging integration, and real-time cardiac magnetic resonance EP guidance. An increasing body of evidence supports the adoption of ZF protocols in managing of the full spectrum of arrhythmias, with feasibility demonstrated without compromise to efficacy or safety. The future of ZF appears highly promising, driven not only by continued refinement of the existing systems but also by the seamless convergence of emerging technologies.
BACKGROUND: Arrhythmias during pregnancy are increasingly prevalent and associated with acute adverse cardiovascular outcomes, yet their long-term cardiovascular implications remain poorly defined. To address this gap, w...BACKGROUND: Arrhythmias during pregnancy are increasingly prevalent and associated with acute adverse cardiovascular outcomes, yet their long-term cardiovascular implications remain poorly defined. To address this gap, we conducted a large population-based study to evaluate 5-year cardiovascular outcomes following incident arrhythmias during pregnancy. METHODS: Using TriNetX, we conducted a retrospective cohort study of pregnant individuals (≥18 years) admitted for delivery between 2015 and 2020. Patients with new-onset arrhythmias during pregnancy were compared with those without arrhythmias. Outcomes included composite cardiovascular outcomes, incident heart failure (HF), cerebrovascular accident (CVA), and acute myocardial infarction (AMI). Propensity score matching (1:1) was used to adjust for demographic and clinical comorbidities. RESULTS: Among 886,732 deliveries, 8507 patients (0.9%) had incident arrhythmias. After matching, individuals with incident arrhythmias during pregnancy had higher 5-year risks of composite cardiovascular outcomes (risk ratios [RR] 3.82), HF (RR 4.48), CVA (RR 2.04), and AMI (RR 4.80) (all P < 0.01). Associations persisted across age strata, with particularly elevated risks among those ≥35 years. CONCLUSIONS: This study, among the first to our knowledge to evaluate long-term cardiovascular outcomes following incident arrhythmias during pregnancy, demonstrates a substantially increased 5-year cardiovascular risk, underscoring the need for extended postpartum cardiovascular surveillance beyond routine follow-up.
BACKGROUND: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation, although the optimal site for ablation remains controversial. METHODS AND RESULTS: We reported a 52- year-old woman with...BACKGROUND: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation, although the optimal site for ablation remains controversial. METHODS AND RESULTS: We reported a 52- year-old woman with the third paroxysmal AF ablation. Mapping showed that the ostial PV ， but not the PV antrum ，was isolated. During circumferential PV antrum ablation, the atrial arrhythmias were eliminated. The roof line and superior vena cava isolation was empirically performed. During the 84-month follow-up, she was free of arrhythmias without antiarrhythmics. CONCLUSION: Isolation of the PV antrum, which was easily to be identify by image integration, should be checked and achieved for patients with AF recurrence after "successful and durable ostial PVI". CLINICAL TRIAL REGISTRATION STATEMENT: No clinical trial registration number is applicable.
BACKGROUND: Anatomical variations of the coronary sinus (CS) may complicate left ventricular lead placement during cardiac resynchronization therapy (CRT). A rare variant, the double-barrel coronary sinus, can result in...BACKGROUND: Anatomical variations of the coronary sinus (CS) may complicate left ventricular lead placement during cardiac resynchronization therapy (CRT). A rare variant, the double-barrel coronary sinus, can result in inadvertent cannulation of non-target tributaries and procedural difficulty. CASE SUMMARY: We report a 45-year-old woman with symptomatic heart failure, left bundle branch block (LBBB), severe left ventricular dysfunction, and left ventricular dyssynchrony who underwent CRT implantation. Levophase coronary angiography demonstrated a double-barrel coronary sinus, with one channel continuing from the posterolateral vein and the other from the anterior interventricular vein. Repeated attempts to access the posterolateral vein preferentially entered the anterior interventricular vein. A modified pull-back technique using a sheath and dual guidewires enabled successful cannulation of the posterolateral branch. Left ventricular lead placement was achieved, resulting in significant QRS narrowing and marked clinical improvement. CONCLUSION: Recognition of double-barrel coronary sinus anatomy and use of alternative wiring techniques can facilitate successful CRT implantation.
BACKGROUND: Left bundle branch area pacing (LBBAP) is increasingly used to achieve more physiological ventricular activation in patients requiring permanent pacing. However, conventional ECG provides only indirect timing...BACKGROUND: Left bundle branch area pacing (LBBAP) is increasingly used to achieve more physiological ventricular activation in patients requiring permanent pacing. However, conventional ECG provides only indirect timing and morphology markers of paced activation and does not directly quantify overall ventricular activation synchrony. Ultra-high-frequency ECG (UHF-ECG) enables quantitative assessment of ventricular activation timing and dyssynchrony beyond QRS duration alone. METHODS: We report a descriptive two-patient comparison of pacing-induced ventricular activation in bradycardia patients with intrinsically narrow baseline QRS complexes who underwent dual-chamber pacemaker implantation with either LBBAP or right ventricular septal pacing (RVSP). Paired pre-implant and early post-implant UHF-ECG recordings were analyzed using ventricular activation maps and quantitative dyssynchrony indices, including ventricular electrical delay (VED) and mean ventricular depolarization time/dispersion (MeanVD). Conventional ECG metrics were assessed in parallel, including paced QRS duration, R-wave peak time (RWPT), V6-V1 interpeak interval, and global RWPT. Because systematic transition testing during decremental output pacing and/or programmed stimulation was not available, formal gold-standard confirmation of LBB capture was not claimed; instead, RWPT-based parameters, LBB score, and global RWPT were treated as supportive ECG-based markers of LBB-area engagement. RESULTS: In the LBBAP case, QRS duration increased modestly from 73.4 to 87.6 ms, while VED18 remained unchanged at -3 ms and MeanVD18 decreased slightly from 25 to 24 ms, indicating preservation of low dyssynchrony. RWPT(V6) was 87.6 ms, RWPT(I) 56.0 ms, RWPT(aVL) 54.8 ms, V6-V1 interpeak interval 34.4 ms, global RWPT 143.6 ms, and simplified LBB score 4. In the RVSP case, QRS duration increased from 93.0 to 135.8 ms, VED16 increased from 2 to 37 ms, and MeanVD16 increased from 30 to 58 ms, indicating substantially greater pacing-induced dyssynchrony. CONCLUSION: UHF-ECG provides reproducible, case-level quantification of pacing-induced ventricular activation and may help distinguish preservation of near-physiological synchrony after LBBAP from dyssynchronous activation during RVSP. These observations are descriptive and hypothesis-generating and should be confirmed in larger comparative cohorts.
BACKGROUND AND AIMS: Atrial fibrillation (AF) ablation traditionally relies on fluoroscopy, exposing both patients and operators to ionizing radiation and lead apron-related occupational harm. Contemporary electroanatomi...BACKGROUND AND AIMS: Atrial fibrillation (AF) ablation traditionally relies on fluoroscopy, exposing both patients and operators to ionizing radiation and lead apron-related occupational harm. Contemporary electroanatomical mapping and intracardiac echocardiography now enable zero-fluoroscopy (ZF) workflows, but comparative evidence regarding their safety and effectiveness remains limited. This study evaluated radiation exposure, procedural safety, procedural duration, and 12-month atrial arrhythmia-free recurrence after ZF versus conventional fluoroscopy (CF)-guided AF ablation. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA. PubMed, MEDLINE, Embase, and Cochrane were searched from January 1, 2014 to 2025 2, March for comparative studies comparing ZF with CF-guided atrial fibrillation ablation in adults. Primary outcomes were radiation exposure, peri-procedural complications, and 12-month atrial arrhythmia-free recurrence. Procedure duration was assessed as a secondary endpoint. Random-effects models were used to pool mean differences and odds ratios, with 95% confidence intervals. RESULTS: Twelve studies involving 1998 patients were included, comprising two randomized controlled trials and ten observational cohorts. Of these, 1098 underwent ZF-guided ablations, and 900 underwent CF-guided ablations. Compared with CF-guided ablation, ZF-guided ablation significantly reduced fluoroscopy time (MD -6.94 min, 95% CI -11.84 to -2.04, p = 0.006) and radiation dose (MD -31.39 mGy, 95% CI -37.44 to -25.35, p < 0.00001). There was no significant difference in 12-month freedom from atrial arrhythmia recurrence (OR 0.98, 95% CI 0.62 to 1.57, p = 0.74) or overall procedural complications (OR 0.73, 95% CI 0.35 to 1.55, p = 0.42). Procedure duration was not significantly different between groups (MD -7.16 min, 95% CI -15.38 to 1.06, p = 0.20). CONCLUSION: ZF-guided ablation for AF substantially reduces radiation exposure without evidence higher procedural complication, 12-month freedom from atrial arrhythmia recurrence or procedure duration compared with CF-guided AF ablation. These findings support broader adoption of ZF-guided ablation in centres with appropriate imaging and mapping expertise, although the certainty of evidence remains limited by heterogeneity and the predominance of observational data included in this study.
BACKGROUND: Left atrial appendage closure (LAAC) is an important approach for stroke prevention in patients with non-valvular atrial fibrillation. Anticoagulation-related spinal epidural hematoma (SEH) and device-related...BACKGROUND: Left atrial appendage closure (LAAC) is an important approach for stroke prevention in patients with non-valvular atrial fibrillation. Anticoagulation-related spinal epidural hematoma (SEH) and device-related thrombosis (DRT) are rare but serious complications. CASE SUMMARY: We report the case of an 86-year-old female who presented with a six-month history of recurrent chest tightness. She was clinically diagnosed with persistent non-valvular atrial fibrillation and chronic heart failure. Following a comprehensive evaluation, she underwent successful LAAC and was started on edoxaban 30 mg once daily for anticoagulation. At six weeks post-procedure, she developed an anticoagulation-related SEH. Anticoagulation was immediately discontinued. Following conservative management, the hematoma resolved and her muscle strength improved. She was subsequently started on clopidogrel 75 mg once daily for antiplatelet therapy. At the six-month follow-up, transthoracic echocardiography and computed tomography angiography confirmed a large DRT in the left atrium. Anticoagulation was re-initiated with low-molecular-weight heparin bridging to warfarin, with the international normalized ratio maintained between 2.0 and 2.5. Follow-up imaging at eight months demonstrated significant resolution of the left atrial thrombus. During the remainder of the follow-up period, no further major adverse events, including ischemic stroke or bleeding, occurred. CONCLUSION: For patients with multiple high-risk factors undergoing LAAC, attention should be paid to dynamic adjustment of individualized antithrombotic strategies, enhancement of perioperative procedural quality control, and structured follow-up within key time windows, in order to minimize the risk of complications and optimize the net clinical benefit.
BACKGROUND: Our previous ex-vivo study showed that shorter inter-lesion time (ILT), defined as the interval between consecutive ablations, enhances lesion depth and may reduce residual conduction during linear ablation....BACKGROUND: Our previous ex-vivo study showed that shorter inter-lesion time (ILT), defined as the interval between consecutive ablations, enhances lesion depth and may reduce residual conduction during linear ablation. Its impact under practical scenarios, such as parallel catheter orientation and shorter inter-lesion distance (ILD), remains unclear. To investigate how ILT, catheter orientation, and ILD affect lesion depth during linear ablation using high-power (HP) and very-high-power short-duration (vHPSD) settings in an ex-vivo model. METHODS: Linear lesions (six per line) were created using the QDOT MICRO catheter (Biosense Webster). Phase 1 evaluated catheter orientation (parallel vs. perpendicular), and Phase 2 compared ILDs (6 mm vs. 4 mm). Minimum perpendicular inter-lesion depths and maximum lesion depths were measured under short ILT (15 s) or long ILT (60 s) using vHPSD (90 W/4 s) or HP (50 W, Ablation Index 350). RESULTS: Short ILT consistently increased maximum and inter-lesion depths across all settings. In Phase 1, parallel orientation produced deeper lesions than perpendicular under HP, whereas under vHPSD, parallel orientation generated shallower lesions. In Phase 2, lesions at ILD 4 mm were deeper than at 6 mm for the same ILT. Notably, short ILT at ILD6 mm achieved inter-lesion depths comparable to long ILT at ILD4 mm, suggesting an additive benefit of ILT shortening, though it cannot replace a short ILD. CONCLUSION: In this proof of concept study, shorter ILTs enhanced lesion depth across all conditions. The effect of catheter orientation varied between HP and vHPSD, suggesting that the optimal strategy to maximize ILT effectiveness depends on ablation setting.
BACKGROUND: Fluoroscopy reduction has become a priority in electrophysiology to mitigate radiation exposure and the musculoskeletal burden of lead apron use. Pulsed field ablation (PFA) offers a favorable safety profile...BACKGROUND: Fluoroscopy reduction has become a priority in electrophysiology to mitigate radiation exposure and the musculoskeletal burden of lead apron use. Pulsed field ablation (PFA) offers a favorable safety profile and efficient pulmonary vein isolation (PVI), making it an attractive platform for fluoroscopy-free workflows. Our aim is to evaluate the feasibility, procedural characteristics, and safety of fluoroscopy-free PFA for atrial fibrillation (AF). METHODS: We searched PubMed/MEDLINE, Embase, and Web of Science from inception through November 2025 for studies evaluating zero- or near-zero-fluoroscopy PFA in adults with paroxysmal or persistent AF. Eligible studies reported at least one feasibility or safety outcome (fluoroscopy time, acute PVI success, procedure duration, complications, or arrhythmia-free survival). Case reports, non-PFA energy sources, and pediatric studies were excluded. Data was extracted on study design, patient characteristics, procedural strategy, and outcomes. The protocol was registered in PROSPERO (CRD420251245538). RESULTS: Five observational studies published in 2025, comprising 260 patients, met inclusion criteria. Mean or median age ranged from 60 to 68 years, and most patients had paroxysmal AF. All procedures used contemporary PFA systems (Farawave, VARIPULSE, or PulseSelect) integrated with EnSite X or CARTO 3 mapping and ICE and/or TEE guidance. Four studies reported fluoroscopy times of 0 min; in the AdmIRE subgroup, fluoroscopy was 0 min in the zero-fluoroscopy group versus a median 2.7 min in the low-fluoroscopy group. Acute PVI was achieved in 100% of cases in all studies reporting this endpoint. Among cohorts with follow-up, freedom from AF ranged from 72.1% to 80%. Major complications were rare: no cardiac tamponade was reported in any fluoroscopy-free cohort, isolated cerebrovascular events occurred only in the larger registry without excess risk in the zero-fluoroscopy group. CONCLUSIONS: Fluoroscopy-free PFA for AF appears highly feasible, with uniform acute PVI success and low complication rates. Integration of echocardiographic guidance enables effective catheter navigation and lesion delivery without radiation. Larger, prospective multicenter studies with longer follow-up are needed to confirm long-term efficacy and safety.
We hereby report a case of a 75-year-old patient who developed a large left-sided hemopneumothorax after a routine dual-chamber pacemaker insertion. The rare complication was caused by the pacing lead injuring the left i...We hereby report a case of a 75-year-old patient who developed a large left-sided hemopneumothorax after a routine dual-chamber pacemaker insertion. The rare complication was caused by the pacing lead injuring the left internal mammary artery (LIMA) after perforating the right ventricle.
Unexpected atrial-like signals appearing after ICD shock in a patient without an atrial lead raise a diagnostic dilemma. In this case, a CRT-D delivered appropriate therapy for ventricular tachycardia, yet post-shock ele...Unexpected atrial-like signals appearing after ICD shock in a patient without an atrial lead raise a diagnostic dilemma. In this case, a CRT-D delivered appropriate therapy for ventricular tachycardia, yet post-shock electrograms suggested an alternative mechanism. Careful analysis revealed phantom crosstalk as the source of this misleading pattern, highlighting a subtle but important pitfall in device interpretation.
Cardiac perforation is a rare complication of cardiac devices implantation. In this case report, a case of a 90-year-old man with early cardiac lead perforation is presented. The combination of capture failure on the ele...Cardiac perforation is a rare complication of cardiac devices implantation. In this case report, a case of a 90-year-old man with early cardiac lead perforation is presented. The combination of capture failure on the electrocardiogram with the malposition of ventricular lead on the chest radiogram raised the suspicion for this complication, while the chest computed tomography confirmed the diagnosis. A hybrid management approach was applied for the removal of the initial ventricular lead. Although cardiac perforation is considered a potentially lethal complication, the early diagnosis and the appropriate treatment strategy can be lifesaving and effective, even for older patients.