Indian Pacing and Electrophysiology Journal最新文献

{"title":"One-year outcomes in patients with persistent atrial fibrillation using CARTOFINDER mapping with OCTARAY: a Shinshu-AB registry study.","authors":"Toshinori Komatsu, Ayako Okada, Hideki Kobayashi, Kiu Tanaka, Hiroaki Tabata, Wataru Shoin, Toshio Kasai, Takahiro Okano, Tatsuya Usui, Yasumasa Nohno, Ryosuke Kozu, Hideaki Sato, Takeshi Tomita, Takahiro Takeuchi, Masao Hirabayashi, Kazunori Aizawa, Yasutaka Oguchi, Yuichi Katagiri, Yasushi Wakabayashi, Koichiro Kuwahara","doi":"10.1016/j.ipej.2026.09.015","DOIUrl":"https://doi.org/10.1016/j.ipej.2026.09.015","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent atrial fibrillation (PerAF) has no established method of catheter ablation. Although catheter ablation using CARTOFINDER has shown some therapeutic effects, the associated prolonged procedure time remains a challenge. The identification of focal or rotational activation sites by CARTOFINDER using OCTARAY™ Mapping Catheter (OCTARAY) suggests that it can more efficiently detect the activation sites owing to its greater coverage of the left atrium (LA). This study aimed to compare the outcomes of catheter ablation guided by CARTOFINDER versus BOX isolation (BOXI) in patients with PerAF.</p><p><strong>Methods: </strong>Using the Shinshu-AB registry, the study included 117 patients with PerAF who underwent catheter ablation between May 2021 and May 2024. The patients were matched at 1:1 ratio (n = 39 each): Group 1 underwent CARTOFINDER-guided catheter ablation, and Group 2 underwent BOXI-guided catheter ablation. CARTOFINDER detection was limited to four sites on the LA posterior wall, the LA appendage ostium, and the LA septum, for a total of six sites.</p><p><strong>Results: </strong>Procedure time was significantly shorter in Group 1 (140.2 ± 37.7 vs. 174.4 ± 74.1 min, p = 0.016). The 1-year AF recurrence rate was significantly lower in Group 1 (17.9% vs. 38.5%, p = 0.031). Based on Cox proportional hazards regression analysis, AF duration and CARTOFINDER-guided catheter ablation were both independent predictors of recurrent AF after catheter ablation for PerAF.</p><p><strong>Conclusion: </strong>Compared to BOXI, CARTOFINDER-guided catheter ablation may lead to better outcomes in patients with PerAF.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence and remote monitoring of cardiac devices: A narrative review.","authors":"Elnaz Shahmohamadi, Shaun C Evans, Melissa E Middeldorp, Prashanthan Sanders","doi":"10.1016/j.ipej.2026.10.003","DOIUrl":"10.1016/j.ipej.2026.10.003","url":null,"abstract":"<p><p>Remote monitoring of Cardiac Implantable Electronic Devices (CIEDs) has evolved significantly from early trans-telephonic transmissions to now becoming a standard of care that improves survival and outcomes. However, the resulting exponential growth in data has resulted in alert fatigue and information overload, creating a need for advanced data interpretation. This narrative review examines the transformative role of Artificial Intelligence (AI) in reshaping remote monitoring and cardiac device management into an active, predictive, and personalised system. We examine the role of AI across all cardiac implantable electronic devices, including implantable loop recorders (ILRs), pacemakers, implantable cardioverter-defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) devices. We address four questions: (1) the scale and nature of the remote monitoring burden; (2) the AI tools in current clinical use, particularly for ILRs, where alert burden is greatest; (3) AI applications evaluated but not yet widely implemented, including prediction of ventricular arrhythmias, heart failure events and device failure; and (4) future directions, including adaptive device programming and digital twins. While AI demonstrates significant potential to enhance clinical decision-making and patient outcomes, its widespread adoption remains constrained by barriers regarding data quality, algorithm transparency, regulatory compliance, and privacy protections. Realising the full potential of AI in electrophysiology will require sustained collaboration between clinical and technical stakeholders to ensure these tools are deployed effectively and safely.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The coronary sinus: A clinical perspective for the electrophysiologist.","authors":"Ahmad Amin, Nayani Makkar, Ishika Gupta, Shivaraj Patil, Abhishek Deshmukh, Samuel J Asirvatham","doi":"10.1016/j.ipej.2026.10.001","DOIUrl":"10.1016/j.ipej.2026.10.001","url":null,"abstract":"<p><p>The coronary sinus (CS) is a specialized cardiac structure whose embryologic and anatomic features may contribute to arrhythmogenesis. Composed of both venous and myocardial elements, it can be conceptualized as a distinct cardiac chamber with connections to both the left and right atria-characteristics that make it an important site for the initiation and maintenance of atrial arrhythmias, as well as a key structure in explaining the underlying physiology of atrioventricular nodal reentrant tachycardia (AVNRT) and the origin of epicardial bypass tracts. The vein, ligament, and myocardial bundle of Marshall arise from the proximal CS and maintain electrical connections with the left atrium and the left-sided pulmonary veins. Because of their electrophysiological and autonomic properties, these structures may contribute to both atrial and ventricular arrhythmias. Furthermore, the proximity of CS tributaries to the ventricular myocardium provides access for the mapping and ablation of selected ventricular arrhythmias, complementing the established role of these vessels in left ventricular pacing.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of heart failure hospitalization in patients with the first marketed leadless pacemaker -Micra VR.","authors":"Mikiko Matsumura, Hitoshi Minamiguchi, Yuki Shibuya, Takashige Sakio, Takashi Kanda, Naoki Mori, Yohei Sotomi, Yasushi Sakata, Osamu Iida","doi":"10.1016/j.ipej.2026.09.011","DOIUrl":"10.1016/j.ipej.2026.09.011","url":null,"abstract":"<p><strong>Introduction: </strong>Micra VR, the first leadless pacemaker, offers a high effectiveness and lower complication rate than conventional transvenous pacemakers. However, little is known about heart failure hospitalization after Micra VR implantation. We investigated the incidence and predictors of heart failure hospitalization in patients who underwent de novo Micra VR implantations.</p><p><strong>Methods: </strong>Ninety-four consecutive patients who underwent de novo Micra VR implantation (mean age 84.6 ± 6.9 years, 45 males) were enrolled. Clinical outcomes were evaluated during follow-up, and predictors of heart failure hospitalization were assessed.</p><p><strong>Results: </strong>During the mean follow-up period of 640 ± 392 days, 17 (18.1%) patients were hospitalized due to heart failure post-implantations. Heart failure hospitalization was associated with a history of atrial fibrillation and reduced left ventricular ejection fraction (LVEF≤50%). Multivariate analysis revealed that a history of AF (hazard ratio [HR], 5.77; 95% confidence interval [CI], 1.64-20.3; P = 0.006) and reduced LVEF (LVEF≤50%) (HR, 7.04; 95% CI, 1.89-26.2; P = 0.004) were independent risk factors for heart failure hospitalization. hospitalization.</p><p><strong>Conclusion: </strong>The presence of AF history and reduced LVEF were predictors of heart failure hospitalization in patients with Micra VR.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A reassuring ECG is not enough in myotonic dystrophy type 1: A systematic review and meta-analysis.","authors":"Feras Shatarat, Osama Bdarnh, Amer A Alomari, Rahaf Alshatarat, Jana Alkasasbeh, Reem Alwahsh, Mariana Qaqish, Obaida Falah, Ruwa Naimat, Husam Abu Odeh, Abdullah Hamad","doi":"10.1016/j.ipej.2026.09.012","DOIUrl":"https://doi.org/10.1016/j.ipej.2026.09.012","url":null,"abstract":"<p><p>Cardiac involvement is a major determinant of morbidity and premature mortality in myotonic dystrophy type 1 (MD1), yet a reassuring surface electrocardiogram (ECG) may not exclude clinically important distal conduction disease. We conducted a systematic review and meta-analysis of cardiac electrical risk stratification in MD1, focusing on occult His-ventricular (HV) prolongation, prognostic ECG and HV abnormalities, and sudden cardiac death (SCD). PubMed/MEDLINE, Scopus, and ScienceDirect were searched from inception through January 31, 2026. The review followed PRISMA 2020 guidance and was prospectively registered in PROSPERO (CRD420261329528). Thirty-three studies were included. Among EPS-evaluated patients, the pooled prevalence of prolonged HV at the 70-ms threshold was 39.8% (95% CI, 36.1%-43.6%). HV ≥ 70 ms was present in 20.0% (95% CI, 13.5%-28.5%) despite study-defined normal or low-risk ECG findings. Surface ECG abnormalities were associated with a higher risk of SCD (pooled relative prognostic effect, 3.11; 95% CI, 1.75-5.52) and, separately, with serious cardiac or conduction-related outcomes (4.77; 95% CI, 2.75-8.28). HV ≥ 70 ms was independently associated with major bradyarrhythmic events and complete atrioventricular block in two adjusted cohorts; these estimates were not pooled because the endpoints differed and cohort independence was uncertain. Across broader longitudinal MD1 cohorts, the pooled cumulative proportion of SCD was 4.0% (95% CI, 3.0%-5.4%). Surface ECG is prognostically informative but cannot reliably exclude clinically relevant His-Purkinje disease. Cardiac risk assessment should therefore be longitudinal, with ECG and ambulatory monitoring forming the foundation and selected EPS providing direct assessment of distal conduction when concern persists.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct atrial fibrillation termination during pulsed field ablation: Association with intracardiac cycle length.","authors":"Eiji Yoshida, Yusuke Sakamoto, Hiroyuki Osanai","doi":"10.1016/j.ipej.2026.09.014","DOIUrl":"10.1016/j.ipej.2026.09.014","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) enables rapid and tissue-selective pulmonary vein isolation (PVI). However, the electrophysiological determinants of direct atrial fibrillation (AF) termination during PFA remain unclear.</p><p><strong>Objective: </strong>To investigate the clinical and electrophysiological characteristics associated with direct AF termination during PFA-guided PVI.</p><p><strong>Methods: </strong>This prospective, single-center study included 72 patients with persistent AF undergoing PFA-based PVI. Intracardiac tachycardia cycle length (TCL) was measured at each pulmonary vein before ablation. Patients were classified into termination and no-termination groups, and clinical and electrophysiological parameters were compared.</p><p><strong>Results: </strong>Direct AF termination occurred in 14 patients (19.4%), most frequently at the right superior pulmonary vein (RSPV) (n = 8), followed by the Left superior pulmonary vein (LSPV) (n = 6). Patients with termination had shorter AF duration, smaller left atrial size, and lower NT-proBNP levels. TCL at the superior pulmonary veins, particularly the RSPV, was significantly longer in the termination group, while no differences were observed at other pulmonary veins. At 3 months, AF recurrence tended to be lower in the termination group, although the difference did not reach statistical significance.</p><p><strong>Conclusion: </strong>Direct AF termination during PFA is associated with favorable clinical characteristics and localized TCL prolongation in the superior pulmonary veins, suggesting their important role in AF maintenance rather than a purely random procedural effect.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping and radiofrequency ablation of left ventricular outflow tract arrhythmias.","authors":"Ramanathan Velayutham, Raja J Selvaraj","doi":"10.1016/j.ipej.2026.09.013","DOIUrl":"10.1016/j.ipej.2026.09.013","url":null,"abstract":"<p><p>Left ventricular outflow tract (LVOT) ventricular arrhythmias comprise one-third of outflow tract ventricular arrhythmias. The LVOT comprises the aortic cusps, infracuspal left ventricle, aortomitral continuity, great cardiac vein, intramural myocardium, and the left ventricular (LV) summit, each providing potential arrhythmogenic sites. Electrocardiographic features provide important initial clues to differentiate LVOT from RVOT origins and further localize arrhythmia sources within the LVOT. However, definitive localization relies on systematic electroanatomic mapping. Electroanatomic mapping involves stepwise mapping strategy incorporating assessment of the RVOT, great cardiac vein-anterior interventricular vein junction, aortic cusps, and left ventricular endocardium. The triangular mapping approach, integrating activation timing across epicardial, endocardial, and cuspal sites, is particularly useful in identifying intramural foci, which are a common cause of ablation failure. Interpretation of electrograms is essential for accurate localization, with characteristic findings such as reversal of high-frequency components in aortic cusp arrhythmias and discordance between unipolar and bipolar signals in intramural origins. Ablation strategies depend on arrhythmia origin. Low-power ablation (≈15 W) is one of the ablation strategies for aortic cusp origin VAs near the left main ostium to reduce risk. Intramural or summit ventricular arrhythmias often require alternative methods, including sequential or simultaneous unipolar ablation, bipolar ablation, specialized irrigants (e.g., half-normal saline), needle-tipped catheters, or ethanol infusion. Even after acute failure, delayed suppression is common due to lesion maturation. A structured approach integrating anatomical knowledge, electrocardiographic interpretation, structured mapping and tailored ablation strategies is key to improving success rates in LVOT ventricular arrhythmias.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impedance changes during intracardiac echocardiography-confirmed catheter contact in pulsed field ablation.","authors":"Kohki Kimura, Hirotoshi Nagae, Yuki Yamamoto, Toka Hamaguchi, Masayuki Shiba, Tetsuya Haruna","doi":"10.1016/j.ipej.2026.09.002","DOIUrl":"10.1016/j.ipej.2026.09.002","url":null,"abstract":"<p><strong>Purpose: </strong>Pulsed field ablation (PFA) has become an established treatment modality for atrial fibrillation (AF). Adequate catheter-to-tissue contact is essential for effective energy delivery. However, impedance characteristics associated with directly visualized catheter contact during PFA have not been well characterized. We evaluated impedance changes measured by the Contact Index during intracardiac echocardiography (ICE)-confirmed catheter contact.</p><p><strong>Methods: </strong>We retrospectively analyzed 30 consecutive patients who underwent index PFA for AF using a pentaspline catheter under a novel impedance measurement system (EnSite X, Abbott). Impedance changes in each pulmonary vein (PV) using both basket and flower configurations were measured. Catheter-to-tissue contact was confirmed by ICE positioned within the left atrium, and impedance changes associated with ICE-confirmed catheter contact were analyzed.</p><p><strong>Results: </strong>A total of 2400 impedance measurements were analyzed. Median impedance changes ranged from 22% to 25% across pulmonary veins. Linear mixed-effects analysis demonstrated that both pulmonary vein location (P < 0.001) and catheter configuration (P < 0.001) were independently associated with impedance change, whereas no significant interaction was observed between pulmonary vein location and catheter configuration (P = 0.084).</p><p><strong>Conclusions: </strong>This study characterizes the distribution of impedance changes observed during ICE-confirmed catheter contact across different pulmonary veins and catheter configurations. These findings provide device-specific descriptive reference data for future prospective validation studies.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodality assessment for sudden cardiac death risk stratification in non-ischemic cardiomyopathy: A case-based framework integrating cardiac magnetic resonance, electrophysiologic observations, and genetics.","authors":"Michael J Litt, Alireza Oraii, Fermin C Garcia, Saman Nazarian, David S Frankel, Rajat Deo, Francis E Marchlinski","doi":"10.1016/j.ipej.2026.09.010","DOIUrl":"10.1016/j.ipej.2026.09.010","url":null,"abstract":"<p><p>Sudden cardiac death (SCD) remains a major cause of mortality in nonischemic cardiomyopathy (NICM) despite advances in heart failure therapy and implantable cardioverter-defibrillator (ICD) technology. Risk stratification remains challenging because left ventricular (LV) ejection fraction (LVEF) alone incompletely captures arrhythmic substrate, missing many patients at risk while leading others to receive ICDs without subsequent appropriate therapy. Cardiac magnetic resonance (CMR), particularly late gadolinium enhancement (LGE), has emerged as a central tool for identifying myocardial fibrosis and refining arrhythmic risk across NICM phenotypes. However, CMR imaging alone does not fully define arrhythmogenicity, especially in diseases with layered, septal, or intramural scar. We present a case-based framework illustrating how multimodality imaging integrates into SCD risk stratification across hypertrophic cardiomyopathy, cardiac sarcoidosis, genetic arrhythmogenic cardiomyopathy, and cardiac amyloidosis. These cases demonstrate several core principles. First, CMR can identify arrhythmogenic substrate and often refines risk beyond conventional clinical markers. Second, multimodality imaging can provide additive information, but findings must be interpreted within disease-specific context, as the prognostic implications differ across phenotypes. Third, invasive electrophysiologic evaluation, including programmed stimulation and electroanatomic mapping, can further stratify arrhythmic risk when imaging findings are incomplete or discordant with the clinical presentation. Finally, genetic testing complements imaging and invasive assessment by refining disease classification and, in selected cases, contributes to arrhythmic risk assessment by considering variant classification and wholistic clinical phenotype. Together, these observations support a substrate-based rather than function-based approach to SCD risk stratification in NICM. Multimodality imaging is foundational, but optimal assessment requires integration of imaging, electrophysiology, genetics, and clinical phenotype. Future progress will depend on longitudinal risk modeling, improved characterization of electrically active substrate, and incorporation of patient-specific tools into primary prevention ICD decision-making.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early intraoperative risk stratification of persistent high pacing threshold after atrial septal pacing with a lumenless 3830 lead: A pilot study.","authors":"Kazuto Hayasaka, Yasuhiro Shirai, Takeshi Sasaki, Hikaru Shimosato, Tomohiro Tahara, Shota Segami, Ryo Nagasawa, Chisashi Toya, Keita Watanabe, Koji Sugiyama, Shu Yamashita, Shinsuke Miyazaki, Tetsuo Sasano","doi":"10.1016/j.ipej.2026.09.006","DOIUrl":"10.1016/j.ipej.2026.09.006","url":null,"abstract":"<p><strong>Background: </strong>Atrial septal pacing with the 3830 lead is increasingly used, but some patients show high pacing thresholds (PT) immediately after fixation, and elevated thresholds may persist. Practical criteria based on early intraoperative findings for identifying such cases have not been established.</p><p><strong>Methods: </strong>We retrospectively studied 53 consecutive patients who underwent cardiac implantable electronic device implantation with the 3830 lead positioned in the high right atrial septum. PT, sensing amplitude, impedance, and current of injury (COI) were measured immediately after fixation, at 5 and 10 min after fixation, post-procedure, at 1 week, and 3 months. The initial high-threshold group was defined as PT ≥ 1.5 V/0.4 ms immediately after fixation. In this group, we evaluated a two-step strategy using PT and COI at 5 min. The primary outcome was PT > 1.0 V/0.4 ms at 1 week.</p><p><strong>Results: </strong>Of 53 patients, 26 were classified into the initial high-threshold group. In this group, PT improved from 2.000[1.750-2.438] V immediately after fixation to 0.750[0.500-0.875] V at 1 week (p < 0.001). Three patients (11.5%) met the primary outcome. PT ≥ 2.5 V/0.4 ms at 5 min yielded 100.0% sensitivity, 95.7% specificity, 75.0% positive predictive value, and 100.0% negative predictive value. In this cohort, adding a 5-min COI cutoff ≤ 2.1 mV to 5-min PT yielded 100.0% for all diagnostic metrics in this cohort.</p><p><strong>Conclusions: </strong>In this pilot study, most cases with high PT immediately after fixation improved within 1 week. A two-step assessment using PT and COI at 5 min after fixation may provide an exploratory framework for intraoperatively stratifying cases at risk of persistent high threshold at 1 week.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}