BACKGROUND: Axillary vein puncture (AVP) is an effective technique in cardiac implantable electronic device (CIED) implantation. This study evaluates the venous tenting (VnT) technique as a novel method and compares its...BACKGROUND: Axillary vein puncture (AVP) is an effective technique in cardiac implantable electronic device (CIED) implantation. This study evaluates the venous tenting (VnT) technique as a novel method and compares its effectiveness to contrast venography (CV) in reducing early and late complications. METHODS: This retrospective multicenter study included 464 patients who underwent CIED implantation using VnT or CV techniques. Patients were matched 1:1 and divided into two groups: Group 1 (n = 232) included those who underwent VnT, and Group 2 (n = 232) included those who underwent CV. Early complications, including pneumothorax (PTX), pocket hematoma (PH), and pocket infection (PI), were collectively defined as total complications (TC). Late complications were defined as device lead integrity (DLI). Independent predictors of complications were identified using multivariate logistic regression analysis. RESULTS: The TC rate was 5.2%. VnT significantly reduced PH rates (0.9% vs. 4.3%, p = 0.019) and TC rates (2.2% vs. 8.19%, p = 0.003) compared to CV. No significant differences were observed between the groups in PTX, PI, or DLI rates. Multivariate logistic regression analysis identified VnT as an independent protective factor for both TC (p = 0.009) and PH (p = 0.022). CONCLUSIONS: During CIED implantation, the VnT technique was associated with lower TC and PH than the CV technique. This study highlights the potential of VnT to improve outcomes. Further prospective studies are recommended to confirm these findings.
BACKGROUND: Cryoablation is commonly used for pediatric atrioventricular nodal reentrant tachycardia (AVNRT) due to its excellent safety profile and nearly zero risk of permanent atrioventricular (AV) block. However, lim...BACKGROUND: Cryoablation is commonly used for pediatric atrioventricular nodal reentrant tachycardia (AVNRT) due to its excellent safety profile and nearly zero risk of permanent atrioventricular (AV) block. However, limited data comparing 6- and 8-mm cryocatheter tips in large pediatric cohorts are available. This study aims to evaluate and compare the procedural characteristics, acute success, and long-term outcomes of 6- and 8-mm cryoablation catheters in children undergoing slow pathway modification for AVNRT. METHODS: We retrospectively reviewed 343 pediatric patients (≤18 years) who underwent cryoablation for AVNRT between 2016 and 2025. Patients were treated with either a 6-mm (n = 182) or an 8-mm (n = 161) cryocatheter. Baseline characteristics, electrophysiological parameters, procedural metrics, complications, and recurrence outcomes were analyzed. All procedures used three-dimensional electroanatomical mapping to improve anatomical accuracy and reduce fluoroscopy exposure. RESULTS: Patients in the 8-mm group were older and heavier and had a higher rate of prior ablation (21.1% vs. 6.0%), indicating greater procedural complexity. Procedure duration, total cryotherapy time, and the number of lesions were significantly longer in the 8-mm group. Acute success rates were excellent in both groups (99.5% vs. 100%), and there were no cases of permanent AV block, pericardial effusion, or major complications. Over a median follow-up of 69 months in the 6-mm group and 30 months in the 8-mm group, recurrence rates were 15.4% and 10.6%, respectively (p = 0.246), showing a favorable but non-significant trend toward fewer recurrences with the 8-mm catheter. CONCLUSION: Both 6- and 8-mm cryoablation catheters offer highly safe and effective treatment for pediatric AVNRT. Despite being used in more complex cases, the 8-mm catheter achieved comparable acute results and showed a potential long-term benefit, supporting its use in selected patient groups.
Daniyal SM, Meer KK, Javaid M
… +11 more, Sarwar M, Khalid A, Hassaan SM, Burhan M, Gul I, Khatoon NM, Asifa S, Ashraf DA, Rizvi A, Hassan IN, Fonarow GC
INTRODUCTION: Right ventricular pacing (RVP) is the standard therapy for atrioventricular (AV) block but may cause ventricular dyssynchrony with long-term use. This meta-analysis evaluates the efficacy and safety of cond...INTRODUCTION: Right ventricular pacing (RVP) is the standard therapy for atrioventricular (AV) block but may cause ventricular dyssynchrony with long-term use. This meta-analysis evaluates the efficacy and safety of conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), as a physiologic alternative to RVP. METHODS: A systematic search was conducted across PubMed, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov from inception to August 2025, for randomized controlled trials (RCTs). Outcomes were analyzed as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) and pooled using the Mantel-Haenszel random-effects model in R (version 4.4.2). RESULTS: Five RCTs enrolling 659 patients were included. CSP was associated with a significant improvement in LVEF compared with RVP (MD: 1.31%; 95% CI: 0.49 to 2.14; p < 0.01). While CSP resulted in a significantly narrower paced QRS duration (MD: -28.44 ms; 95% CI: -38.96 to -17.92; p < 0.01), the procedure time was longer with CSP (MD: 25.86 min; 95% CI: 23.09 to 28.63; p < 0.01). The risk of device and lead-related complications was comparable between cohorts (RR: 1.35; 95% CI, 0.28 to 6.63; p = 0.71). CONCLUSION: Conduction system pacing (CSP) slightly improves LVEF and achieves a significantly narrower paced QRS compared with right ventricular pacing (RVP). Although associated with longer procedure times, CSP does not increase device- or lead-related complications. These findings suggest that CSP offers more physiological ventricular activation while maintaining comparable safety to conventional RVP. TRIAL REGISTRATION: PROSPERO number: CRD420251152303.
BACKGROUND: Right ventricular (RV) lead perforation is a rare but potentially life-threatening complication of cardiac implantable electronic devices. Although apical lead placement has been proposed as a risk factor, it...BACKGROUND: Right ventricular (RV) lead perforation is a rare but potentially life-threatening complication of cardiac implantable electronic devices. Although apical lead placement has been proposed as a risk factor, its clinical significance remains uncertain. This study evaluated whether apical RV lead positioning increases perforation risk and characterized the clinical features, diagnosis, and outcomes of affected patients. METHODS: We retrospectively reviewed data from 1,923 patients who underwent RV lead implantation between January 2002 and June 2023. Patients were categorized into Apex and Non-apex groups according to lead tip location. RV lead perforation cases were identified based on chest radiography findings. Baseline characteristics and the incidence and management of lead perforation were analyzed. RESULTS: Among the 1,923 patients, 503 (26.2%) were assigned to the Apex group and 1,420 (73.8%) to the Non-apex group. RV lead perforation occurred in 5 patients (0.26%): 4 in the Apex group and 1 in the Non-apex group (0.79% vs. 0.07%, p = 0.018). Perforations were diagnosed intraoperatively or within 1-3 days post-implantation, primarily using chest computed tomography. Clinical presentations ranged from asymptomatic findings to chest pain. All patients underwent percutaneous RV lead extraction and revision, without major complications. CONCLUSION: Apical RV lead positioning was significantly associated with an increased risk of lead perforation. Although perforation was uncommon, prompt diagnosis and individualized management ensured favorable outcomes. Careful attention to lead tip location during implantation may help mitigate this risk. Given the small number of events, this finding should be interpreted as hypothesis-generating.
Abomohsen M, Mohamed AE, Almakadma AH
… +10 more, Mojahedi A, Kholeif Z, Elalfy A, Shams M, Gadelmawla AF, Tahhan IS, Elnashar M, Rashwan R, Elnady M, Gunsburg M
BACKGROUND: The optimal long-term antithrombotic strategy after apparently successful catheter ablation of atrial fibrillation (AF) remains uncertain, particularly in patients who meet conventional guideline thresholds f...BACKGROUND: The optimal long-term antithrombotic strategy after apparently successful catheter ablation of atrial fibrillation (AF) remains uncertain, particularly in patients who meet conventional guideline thresholds for oral anticoagulation (OAC). OBJECTIVES: To compare continuation versus cessation strategies of long-term OAC after successful AF ablation and to quantify net clinical benefit (NCB) integrating thromboembolic and bleeding outcomes. METHODS: We searched PubMed, Cochrane CENTRAL, and Embase from inception through February 2026 for randomized and comparative observational studies evaluating long-term OAC continuation versus cessation (no OAC and/or switch to aspirin) after successful AF ablation. Risk of bias was assessed using RoB2 for randomized trials and a modified Newcastle-Ottawa Scale (NOS) for observational studies. Random-effects meta-analyses used a restricted maximum likelihood estimator with Hartung-Knapp adjustment. NCB was calculated as: thromboembolic event rate - (1.5 × major bleeding rate). RESULTS: Six studies met the inclusion criteria (four randomized trials and two observational cohorts). Stroke/transient ischemic attack (TIA) events were reported in six studies and were not significantly different between OAC continuation and cessation strategies (OR 0.69; 95% CI 0.24-1.99; p = 0.49). Systemic embolism (three studies) did not differ between groups (p = 0.12). Major bleeding (five studies) was numerically higher with continued OAC but not statistically significant (OR 2.07; 95% CI 0.88-4.86; p = 0.09). In NCB analysis, continued OAC yielded more negative or near-neutral NCB values, whereas, the cessation strategies were less negative or marginally positive; the fixed-effect risk difference in NCB (continued OAC vs cessation) was +0.00067 (95% CI -0.00279 to +0.00413). CONCLUSION: This meta-analysis suggests that after successful AF ablation, continuing OAC does not significantly reduce stroke risk compared to cessation or switching to aspirin, but it may increase major bleeding. While NCB trends favor cessation, the low absolute event rates and the risk of silent AF recurrence necessitate caution.
Žlahtič T, Starc V, Žižek D
… +5 more, Rauber M, Antolič B, Mrak M, Ivanovski M, Mežnar AZ
Pacing Clin Electrophysiol
· 2026 Jul · PMID 41863846
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Conduction system pacing (CSP) is an emerging new method of cardiac resynchronization therapy (CRT), however, one third of patients with left bundle branch block (LBBB) have distal conduction disease, which is not amenab...Conduction system pacing (CSP) is an emerging new method of cardiac resynchronization therapy (CRT), however, one third of patients with left bundle branch block (LBBB) have distal conduction disease, which is not amenable to correction with CSP. There is an emerging need for tailored analysis of ventricular depolarization patterns for patient selection for CRT pacing modality. We retrospectively analyzed 12 lead hrECGs, equivalent dipole (ED) trajectories and standard transthoracic echocardiograms of 18 heart failure patients fulfilling Strauss criteria for LBBB and indication for CRT randomized to the CSP arm of the ongoing CSP-Sync study (NCT05155865). Based on achievement of left bundle branch capture with shortening of left ventricular activation time, 12 patients had proximal LBBB (pLBBB group), and 6 had intact proximal LBBB conduction (dLBBB group) with similar average baseline QRS durations between the groups (179±14 ms in the pLBBB and 165±20 ms in the dLBBB group, p = 0.1). All patients fulfilled the Strauss criteria with no significant difference in the additional criterion (R wave > 0.1 mV in V1; p = 0.7). In the pLBBB group ED trajectory had an initial leftward direction (six vs. zero patients, p = 0.03) with a uniform (12 vs. one patient, p < 0.001) and slower (0.57 ± 0.12 m/s in the pLBBB vs. 0.75 ± 0.15 m/s in the dLBBB group, p = 0.01) velocity. After 6 months the pLBBB group achieved greater relative QRS duration shortening (26% ± 8% vs. 14% ± 9%; p < 0.02) and relative reductions in end left ventricle systolic volumes (41.3% ± 17.6% vs. 15.8% ± 6.1%; p = 0.004) with better improvement in ejection fraction (17.1% ± 11.0% vs. 5.5% ± 1.0%; p = 0.02). The ED trajectories from 12-lead hrECGs could better differentiate patients with proximal or distal LBBB than standard 12-lead ECG alone.
INTRODUCTION: Young populations with traditional dual-chamber pacemakers are prone to re-intervention compared to their adult populations due to their active lifestyle. AVEIR DR Dual-Chamber Leadless Pacemakers are a new...INTRODUCTION: Young populations with traditional dual-chamber pacemakers are prone to re-intervention compared to their adult populations due to their active lifestyle. AVEIR DR Dual-Chamber Leadless Pacemakers are a new and less invasive approach to traditional pacemakers. Currently, few reports exist to support dual-chamber leadless pacemaker implants in the young. METHODS: AVEIR DR dual-chamber leadless pacemakers were implanted in young patients (< 21 years old), at UC Davis Medical Center. Internal jugular vein was the preferred approach for most patients during implantation; however, one patient had a femoral approach after lead extraction. RESULTS: Five patients received the AVEIR DR dual-chamber leadless pacemaker with a median age of 15 years, and a median weight of 65.8 kg. Access from the internal jugular vein was used in four out of five patients. Median predicted atrial longevity and ventricular longevity were 11.8 and 14.6 years, respectively. Atrial and ventricular impedance, threshold, and pacing were monitored with no complications with a median follow-up of 13 months. CONCLUSION: Dual-chamber leadless pacemaker implants are feasible in young patients through femoral and internal jugular vein access.
Abdrakhmanov A, Marat G, Yessimbekova E
… +1 more, Suleymen Z
Pacing Clin Electrophysiol
· 2026 Jun · PMID 41852129
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Leadless pacing systems have evolved toward modular configurations that enable staged restoration of atrioventricular (AV) synchrony without transvenous leads. Real-world experience with a sequential upgrade from AVEIR V...Leadless pacing systems have evolved toward modular configurations that enable staged restoration of atrioventricular (AV) synchrony without transvenous leads. Real-world experience with a sequential upgrade from AVEIR VR to a dual-chamber AVEIR DR system remains limited. We report a case of staged modular leadless upgrade performed in a patient with progressive sinus node dysfunction, intermittent high-grade AV block, and symptomatic loss of AV synchrony following prior ventricular leadless pacing. A 74-year-old man with a history of mitral valve repair and atrial flutter ablation initially received an AVEIR VR ventricular device. One year later, he developed sinus pauses and hemodynamic symptoms related to AV dyssynchrony. Because the patient declined transvenous pacing, an atrial AVEIR AR module was implanted to establish dual-chamber pacing within a fully leadless system. The procedure was uncomplicated and resulted in restoration of AV synchrony and clinical improvement at follow-up. This report demonstrates the feasibility of staged modular upgrades within a leadless pacing platform in selected patients with evolving conduction disease.
Pulsed field ablation (PFA) has emerged as a new energy source for atrial fibrillation (AF) ablation, distinguished by its tissue-selective mechanism through irreversible electroporation. PFA offered theoretical advantag...Pulsed field ablation (PFA) has emerged as a new energy source for atrial fibrillation (AF) ablation, distinguished by its tissue-selective mechanism through irreversible electroporation. PFA offered theoretical advantages over conventional radiofrequency and cryoablation techniques, particularly regarding collateral damage to phrenic nerve and esophagus. However, accumulating evidence challenges this paradigm, with growing data highlighting those thermal effects are possible and may be clinically relevant during PFA procedures. No significant esophageal complications have been reported to date, but continued vigilance is warranted given the rapidly increasing number of procedures, the trend toward multiple lesions on the posterior wall and in consideration of new PFA catheters arriving in clinical practice. This article examines current evidence on esophageal warming during PFA.
BACKGROUND: Skin thinning over cardiac implantable electronic devices (CIEDs) is frequently observed; however, its clinical implications and temporal progression remain unclear. This study aimed to investigate the clinic...BACKGROUND: Skin thinning over cardiac implantable electronic devices (CIEDs) is frequently observed; however, its clinical implications and temporal progression remain unclear. This study aimed to investigate the clinical significance of skin thickness over CIEDs by examining its association with adverse outcomes, including all-cause mortality and device-related infections, and evaluating its temporal changes and associated clinical factors. METHODS: This study included 96 patients who underwent ultrasonographic measurement of skin thickness over CIEDs between June 2020 and June 2021. Adverse outcomes were monitored through August 2023. Of those, 34 patients had follow-up ultrasonography to assess temporal changes in skin thickness. RESULTS: Among 34 patients with repeated measurements, skin thickness significantly declined over a median of 42 (IQR: 41-44) months (p = 0.001), and thinning was correlated with changes in hemoglobin levels (r = 0.392, p = 0.024). During a median follow-up of 32 (IQR: 11-34) months, patients with skin thickness ≤ 3.3 mm (thin group) had significantly higher all-cause mortality than those with a thickness > 3.3 mm (normal group) (log-rank p < 0.001). In multivariable Cox regression analysis, skin thickness ≤ 3.3 mm remained an independent predictor of mortality (HR 2.42; 95% CI, 1.01-5.80; p = 0.046). Device-related infections were more frequent in the thin group (8%) than in the normal group (2%), but the difference was not statistically significant. CONCLUSIONS: Skin thickness over CIEDs progressively declined over time and was significantly correlated with hemoglobin levels. In addition, skin thickness ≤ 3.3 mm was independently associated with increased all-cause mortality.
Kawamura I, Miyazaki S, Kato R
… +12 more, Takahashi K, Negishi M, Honda M, Tateishi R, Goto K, Nishimura T, Yamao K, Takahashi K, Ihara K, Tao S, Takigawa M, Sasano T
INTRODUCTION: Hemolysis is a recognized complication of endocardial pulsed field ablation (PFA), and its severity is influenced by factors such as the number of applications, tissue contact, and characteristics of the PF...INTRODUCTION: Hemolysis is a recognized complication of endocardial pulsed field ablation (PFA), and its severity is influenced by factors such as the number of applications, tissue contact, and characteristics of the PFA system. However, most existing data are based on the Pentaspline catheter, and limited information is available regarding hemolysis with other PFA systems. METHODS AND RESULTS: We evaluated hemolysis in seven consecutive patients with paroxysmal atrial fibrillation undergoing PFA using a variable-loop irrigated circular catheter (VLCC; Varipulse, Biosense Webster) and a dedicated generator (TRUPULSE). All procedures included pulmonary vein and posterior wall isolation, guided by a tissue proximity indicator (TPI). A median of 32 applications was delivered per patient. Plasma-free hemoglobin levels significantly increased from 0.01 (0.00-0.01) g/dL before the procedure to 0.05 (0.04-0.06) g/dL after the procedure (p < 0.001). Post-procedural reductions in hemoglobin levels and increases in bilirubin and lactate dehydrogenase levels were also observed, along with subnormal haptoglobin levels in 50% of patients. Creatine kinase levels increased significantly from 84 (82-146) U/L preoperatively to 323 (272-369) U/L postoperatively (p = 0.018). No cases of acute kidney injury occurred, and renal function remained stable post-procedure. CONCLUSION: This is the first study to evaluate hemolysis with a VLCC-based PFA using plasma-free hemoglobin as a biomarker. These findings underscore the importance of evaluating each PFA system individually to better understand their safety and biophysical effects.
BACKGROUND: Durable mitral isthmus (MI) block remains challenging in persistent atrial fibrillation (AF) ablation. Ethanol infusion into the vein of Marshall (EI-VOM) enhances efficacy, but the minimal endocardial ablati...BACKGROUND: Durable mitral isthmus (MI) block remains challenging in persistent atrial fibrillation (AF) ablation. Ethanol infusion into the vein of Marshall (EI-VOM) enhances efficacy, but the minimal endocardial ablation extent post-EI-VOM is undefined. METHODS: This prospective study (June 2024-March 2025) enrolled 35 persistent AF patients undergoing first-time ablation: EI-VOM (11.10 ± 2.24 mL ethanol), bilateral pulmonary vein isolation (PVI), linear ablations, and stepwise MI ablation. Endpoints included acute MI block, lesion requirements, and 6-month sinus rhythm (SR) maintenance. RESULT: Left PVI demonstrated significantly shorter ablation time versus right-sided PVI (10.94 ± 5.31 min vs. 18.77 ± 7.27 min, p < 0.01), while acute MI block was achieved in 88.6% (31/35) of patients with 5.03 ± 4.51 endocardial lesions-notably fewer in smaller left atria (diameter <45 mm: 4.1 ± 3.9 vs. ≥45 mm: 6.8 ± 5.1 lesions, p = 0.03). EI-VOM enabled 90% of MI blocks with partial endocardial ablation. SR maintenance reached 91.4% (3-month) and 88.5% (6-month), showing no correlation with MI block or clinical variables (p > 0.05), with zero major complications recorded. CONCLUSIONS: EI-VOM synergizes with partial endocardial ablation for MI block, particularly in non-dilated left atria (<45 mm). Adjunctive coronary sinus ablation is essential for dilated atria. High mid-term SR stability (88.5%) supports strategy efficacy, though non-anatomical factors influence recurrence.
INTRODUCTION: Surgical left atrial appendage occlusion (sLAAO) reduces stroke in patients with atrial fibrillation (AF), but its benefit in those without pre-existing AF, when performed prophylactically with cardiac surg...INTRODUCTION: Surgical left atrial appendage occlusion (sLAAO) reduces stroke in patients with atrial fibrillation (AF), but its benefit in those without pre-existing AF, when performed prophylactically with cardiac surgery, remains unclear. Further, the role of anticoagulation in patients who develop new AF or atrial flutter (AF/AFL) after sLAAO is not well defined. Given that new-onset AF commonly occurs after coronary artery bypass grafting (CABG), we aimed to compare outcomes between anticoagulation and no anticoagulation in patients developing new AF/AFL following CABG-sLAAO. METHODS: Using TriNetX, we identified patients with prior CABG-sLAAO who subsequently developed new AF/AFL. Those with pre-existing AF/AFL and those who underwent percutaneous LAAO were excluded. Patients were categorized based on whether they received anticoagulation or not. Propensity score matching (PSM) was used to balance baseline characteristics, achieving a standardized mean difference of <0.1. Outcomes included ischemic stroke, major bleeding (per ISTH criteria), and all-cause mortality. RESULTS: Out of 549 patients receiving anticoagulation and 1,004 not receiving anticoagulation, we identified 451 well-matched pairs. The mean age was 69 years, with >75% being male and >75% being White. Hypertension and type 2 diabetes were present in approximately 70% and 45% of the patients, respectively. Over 90% of the patients were on aspirin, beta-blockers, and lipid-lowering agents. There was no significant difference in risk of ischemic stroke (9.3% vs. 7.3%; risk ratio [RR] 1.27, 95% confidence interval [CI] 0.82-1.97, p = 0.28) or all-cause mortality (9.6% vs. 11.2%; RR 0.86, 95% CI 0.58-1.26, p = 0.43), but risk of major bleeding was higher with anticoagulation (10.6% vs. 5.2%; RR 2.04, 95% CI 1.15-3.62, p = 0.013). CONCLUSIONS: Among patients developing new AF/AFL after CABG-sLAAO, anticoagulation was not associated with lower risk of stroke or mortality but was linked to significantly greater bleeding risk. These findings suggest a limited incremental benefit of anticoagulation in this population and highlight the need for prospective evaluation.
BACKGROUND: Transcatheter Aortic Valve Replacement (TAVR) carries a notable risk of conduction system injury. While most atrioventricular (AV) blocks occur early, predictors of late-onset AV block and its latest timing r...BACKGROUND: Transcatheter Aortic Valve Replacement (TAVR) carries a notable risk of conduction system injury. While most atrioventricular (AV) blocks occur early, predictors of late-onset AV block and its latest timing remain uncertain. CASE SUMMARY: A 63-year-old man who developed complete AV block 17 months after TAVR (Evolut-R 29 mm). Serial electrocardiograms showed progressive warning signs: left anterior fascicular block at one month, complete left bundle branch block (LBBB) with first-degree AV block at one year, and, ultimately, complete AV block. Electrophysiological study demonstrated AH and HV intervals of 75 ms and 78 ms, respectively. Prolonged ambulatory monitoring revealed intermittent high-grade AV block. The patient underwent left bundle branch pacing (LBBP), which provided physiologic ventricular activation and corrected the conduction abnormalities; symptoms resolved and pacing parameters remained stable on follow-up. CONCLUSION: Complete AV block can present extremely late after TAVR. Even subtle ECG abnormalities should be regarded as warning signs and prompt prolonged rhythm surveillance. LBBP is a physiologic pacing strategy that can both ensure reliable pacing and restore ventricular conduction.
Prepolec I, Pašara V, Nekić A
… +6 more, Katić Z, Nikolić BP, Puljević M, Puljević D, Miličić D, Velagić V
Pacing Clin Electrophysiol
· 2026 Jun · PMID 41834700
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BACKGROUND: The impact of various imaging techniques on the safety and outcomes of atrial fibrillation (AF) ablation remains unclear. Intra-procedural three-dimensional rotational angiography (3DRA) is the least used ima...BACKGROUND: The impact of various imaging techniques on the safety and outcomes of atrial fibrillation (AF) ablation remains unclear. Intra-procedural three-dimensional rotational angiography (3DRA) is the least used imaging method despite some benefits. The aim is to assess its impact on procedural success, safety, and long-term outcomes of cryoballoon (CB) ablation. METHODS: A single-center, unblinded, randomized controlled trial enrolled 134 patients (64.2% male, 59.0 ± 11.6 years) with paroxysmal (93.3%) or early-persistent AF. Participants were randomized to no imaging or 3DRA. Angiographic images were used to guide the ablation. Follow-up data regarding procedure and AF recurrence were collected during 12 months. RESULTS: 66 (49.3%) patients underwent 3DRA. In the control group, 2 (2.9%) pulmonary veins (PVs) could not be isolated, compared with 3 (4.5%) in the 3DRA group (p = 0.636). Procedure was longer in the 3DRA group (86.7 ± 27.8 min vs. 67.2 ± 22.1 min, p < 0.001), with significantly higher radiation dose (447.4 ± 485.0 mGy vs. 133.9 ± 166.2 mGy, p < 0.001) and contrast use (131.8 ± 28.3 mL vs. 40.8 ± 26.5 mL, p < 0.001). At 12 months, 88.2% of patients in the control group and 86.2% in the 3DRA group were free of AF (p = 0.798). CONCLUSION: 3DRA did not improve procedural success or long-term outcomes of CB ablation but significantly increased procedure time, radiation dose, and contrast usage.
T-Wave oversensing (TWOS) is a type of pacemaker malfunction that can result in inappropriate tachyarrhythmia detection and loss of pacing, attenuating potential benefits of cardiac resynchronization therapy (CRT). We pr...T-Wave oversensing (TWOS) is a type of pacemaker malfunction that can result in inappropriate tachyarrhythmia detection and loss of pacing, attenuating potential benefits of cardiac resynchronization therapy (CRT). We present a case series of TWOS after left bundle branch pacing (LBBP) in the First Affiliated Hospital of Nanjing Medical University from 2020 to 2024. By analyzing underlying mechanisms and summarizing feasible solutions, we highlight the particularity and complexity of TWOS. It can occur immediately after procedure or be detected after a relatively long period of time. The harm of TWOS should be dealt with in a timely manner.
We report a 27-year-old man presenting with paroxysmal palpitations due to alternating wide and narrow QRS tachycardias that transitioned without termination. Based on Coumel's law, an accessory pathway-mediated mechanis...We report a 27-year-old man presenting with paroxysmal palpitations due to alternating wide and narrow QRS tachycardias that transitioned without termination. Based on Coumel's law, an accessory pathway-mediated mechanism was initially suspected for both tachycardias. However, the wide QRS tachycardia was ultimately confirmed to be ventricular tachycardia. Although Coumel's law may aid in the diagnosis of tachycardias with alternating QRS widths, potential confounding factors must be carefully considered to prevent misdiagnosis.
BACKGROUND: The prognostic implications of atrial fibrillation (AF) burden in pulmonary embolism (PE) remains unclear. This study aimed to investigate the relationship between AF burden and prognosis in PE patients. METH...BACKGROUND: The prognostic implications of atrial fibrillation (AF) burden in pulmonary embolism (PE) remains unclear. This study aimed to investigate the relationship between AF burden and prognosis in PE patients. METHODS: In this retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV v2.0) database, patients with confirmed PE diagnosis were included. AF burden was calculated as the percentage of total AF duration relative to total records duration using nurse-documented continuous electronic monitoring (CEM) records. Patients with AF were dichotomized into low-burden and high-burden groups using an optimal cut-off value of 12.0%. Multivariable Cox proportional hazards models were employed to evaluate the 1-year all-cause mortality risk across sinus rhythm (SR), low-burden, and high-burden AF groups. RESULTS: Among 1,175 patients, 246 (20.9%) had AF, comprising 84 cases of low-burden AF and 162 cases of high-burden AF. The 1-year all-cause mortality rates were 22.1% (SR), 26.2% (low-burden AF), and 40.7% (high-burden AF), respectively. After full adjustment, high-burden AF demonstrated a significant association with 1-year all-cause mortality (HR: 1.67, 95% CI: 1.22-2.29, p = 0.001), whereas low-burden AF showed no statistically significant association (HR: 0.97, 95% CI: 0.62-1.53, p = 0.906). The robustness of these associations was maintained in subgroup and sensitivity analyses. Restricted cubic spline (RCS) analysis identified a nonlinear relationship between AF burden and 1-year all-cause mortality risk, demonstrating an inverted U-shaped dose-response pattern (P for non-linearity = 0.022). CONCLUSIONS: High AF burden independently predicted 1-year all-cause mortality in PE patients, suggesting its clinical utility for risk stratification.