Pacing and clinical electrophysiology : PACE最新文献

{"title":"Leadless Pacemakers After Transcatheter Aortic Valve Replacement: A Meta-analysis With Time-to-Event Analysis.","authors":"Frengki Prabowo Saputro Wijayanto, Christopher Daniel Tristan, Muhammad Reva Aditya, Artha Maressa Theodora Simanjuntak, Raymond Pranata","doi":"10.1111/pace.70468","DOIUrl":"https://doi.org/10.1111/pace.70468","url":null,"abstract":"<p><strong>Background: </strong>Permanent pacemaker implantation is a common complication after transcatheter aortic valve replacement (TAVR). Leadless pacemakers (LPs) may reduce lead- and pocket-related complications, but their clinical outcomes after TAVR remain uncertain. This systematic review and meta-analysis evaluated the safety and effectiveness of LPs compared with transvenous pacemakers (TVPs).</p><p><strong>Methods: </strong>PubMed, Scopus, and ScienceDirect were searched from inception to June 10, 2026. Randomized and observational studies were included. Random-effects meta-analyses pooled proportions, risk ratios (RRs), and mean differences (MDs). Reconstructed Kaplan-Meier data were used to estimate hazard ratios (HRs).</p><p><strong>Results: </strong>Ten studies involving 10,809 patients (1030 LP and 9779 TVP recipients) were included. The pooled procedural success rate of LP implantation was 98% (95% CI 95%-99%). Implantation success was comparable between LP and TVP (RR 1.00, 95% CI 0.98-1.02). Sensitivity analysis demonstrated a shorter hospital stay with LP (MD -1.37 days, 95% CI -2.33 to -0.41) and a lower risk of heart failure hospitalization (RR 0.37, 95% CI 0.14-0.96). Overall survival did not differ between groups (HR 1.05, 95% CI 0.44-1.23), although reconstructed survival curves showed late separation favoring LP. Device-related and vascular complications were comparable between LP and TVP.</p><p><strong>Conclusions: </strong>LP implantation after TAVR demonstrates excellent procedural success and clinical outcomes comparable to TVPs. LPs may reduce hospital stay and heart failure hospitalization, supporting their use as an alternative pacing strategy in appropriately selected patients.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187828","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":"Open-Irrigated Versus Non-Irrigated Catheters in SVT Ablation: Substrate-Specific Outcomes in AVRT and AVNRT.","authors":"Marcos Javier Duarte-Sau, José Cruz Arzola-Hernández, Nancy Elena Guzmán-Delgado, Luis Gerardo González-Barrera","doi":"10.1111/pace.70471","DOIUrl":"https://doi.org/10.1111/pace.70471","url":null,"abstract":"<p><strong>Background: </strong>Open-irrigated catheters (OIC) provide improved cooling, deeper lesion formation, and enhanced safety during radiofrequency catheter ablation (RFCA). However, comparative evidence regarding substrate-specific outcomes with OIC versus non-irrigated catheters (NIC) for supraventricular tachycardia (SVT) remains limited. This study compared acute ablation success (AAS) and recurrence after first-time RFCA using OIC versus NIC, with particular emphasis on differential outcomes in atrioventricular re-entrant tachycardia (AVRT) and atrioventricular re-entrant tachycardia (AVNRT).</p><p><strong>Methods: </strong>A retrospective cohort of consecutive patients undergoing first-time RFCA for AVNRT or AVRT between 2017 and 2023 was analyzed. Patients were categorized by catheter type (OIC vs. NIC). Primary outcomes were AAS and SVT recurrence during 24-month follow-up. Multivariate logistic regression and Cox proportional hazards models were used for adjusted analyses. Subgroup analyses were performed for AVNRT and AVRT.</p><p><strong>Results: </strong>Among 302 procedures, OIC were used in 113 (37.4%). Overall AAS was achieved in 85.4% of cases (92.0% OIC vs. 81.5% NIC; p = 0.012). Recurrence occurred in 17.9% (7.1% OIC vs. 24.3% NIC; p < 0.001). In multivariable analyses, OIC use was independently associated with higher AAS (adjusted RR 1.12; 95% CI 1.05-1.20; p = 0.001) and lower recurrence (adjusted HR 0.24; 95% CI 0.12-0.52; p < 0.001). In the AVRT subgroup, OIC use was associated with higher AAS (89.9% vs. 76.6%; p = 0.014) and lower recurrence (adjusted HR 0.25; 95% CI 0.11-0.57; p < 0.001), whereas no significant differences were observed in AVNRT.</p><p><strong>Conclusions: </strong>In this cohort, OIC use was associated with higher AAS and lower recurrence, with the favorable association primarily observed in AVRT rather than AVNRT. These findings support further evaluation of substrate-specific catheter selection, particularly for accessory pathway ablation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187824","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":"Pulsed Field Versus Radiofrequency Ablation of Atrial Fibrillation: Esophageal Lesions and Suspected Gastroparesis.","authors":"Atsushi Murakami, Koji Fukuzawa, Mitsuru Takami, Kimitake Imamura, Hirofumi Abe, Hidehiro Iwai, Mitsuhiko Shoda, Shogo Yonehara, Hiroyuki Asada, Takahiro Kunigita, Mari Yamamoto, Ryosuke Takahashi, Takafumi Tsuboi, Takahito Nakano, Wako Suehiro, Ken-Ichi Hirata, Hiromasa Otake","doi":"10.1111/pace.70472","DOIUrl":"https://doi.org/10.1111/pace.70472","url":null,"abstract":"<p><strong>Background: </strong>Esophageal mucosal injury and gastroparesis are clinically important complications of radiofrequency ablation (RFA) of atrial fibrillation (AF). Pulsed-field ablation (PFA) is a non-thermal modality that may spare these complications due to its myocardial tissue selectivity.</p><p><strong>Objectives: </strong>We aimed to compare the incidence of endoscopically detected esophageal lesions (EDELs) and suspected gastroparesis between RFA and PFA as the primary endpoints. Secondary endpoints included perioperative complications, procedural parameters, and 365-day clinical outcomes.</p><p><strong>Methods: </strong>Between July 2023 and July 2025, patients undergoing a first-time AF ablation with RFA or PFA were enrolled. RFA was performed using either a QDOT MICRO catheter (Biosense Webster, Inc., Irvine, CA, USA) or a TactiFlex Ablation Catheter, Sensor Enabled (Abbott, Abbott Park, IL, USA), while PFA was performed using the FARAPULSE system or the PulseSelect system. All patients underwent upper gastrointestinal endoscopy on the day after ablation. An EDEL was defined as esophageal erythema, erosion, ulcer, or atrio-esophageal fistula. Suspected gastroparesis was defined as gastric food residue after > 12 h of overnight fasting. Clinical follow-up was performed with 12-lead or Holter electrocardiography.</p><p><strong>Results: </strong>A total of 84 patients were included (RFA: n = 43; PFA: n = 41). Esophageal erosion was observed in 2 patients in the RFA group (4.7%) and in none in the PFA group (p = 0.49). Suspected gastroparesis occurred in 15 patients treated with RFA (34.9%) and in none treated with PFA (P<0.001). All patients were asymptomatic during endoscopy. No other procedural complications were observed in either group. The total procedure time was significantly shorter with PFA (158.5 ± 40.8 vs. 193.8 ± 38.3 min, p < 0.001), while the fluoroscopy time was longer. At 365 days, atrial arrhythmia recurrence rates were comparable between the two groups (p = 0.47).</p><p><strong>Conclusions: </strong>In this single-center cohort, PFA was associated with a significantly lower incidence of suspected gastroparesis than RFA, and no EDELs were observed in the PFA group. PFA may reduce gastrointestinal injury associated with AF ablation. Further studies are needed to confirm these findings and clarify their clinical significance.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186737","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":"Timing of Catheter Ablation After Heart Failure Diagnosis for Atrial Fibrillation: A Propensity-Score-Matched Analysis.","authors":"Ahmad Al-Abdouh, Omar Obeidat, Laith Alhuneafat, Samarth Goyal, Abdallah Rayyan, Qusai Alqudah, Suhaib Khateeb, Shubhika Jain, Abdalhakim Shubietah, Ahmad Ma'aita, Henri Roukoz, Jorge Reyes Castro, David Benditt, Wissam Khalife, Dustin Staloch, Arun Narayanan, Muhie Dean Sabayon, Mohammed Al-Sadawi","doi":"10.1111/pace.70466","DOIUrl":"https://doi.org/10.1111/pace.70466","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation improves outcomes in patients with atrial fibrillation (AF) and heart failure (HF). However, most of the evidence on the importance of ablation timing has been anchored to AF rather than HF onset, leaving the optimal interval between HF diagnosis and ablation incompletely defined.</p><p><strong>Objectives: </strong>To evaluate the association between the timing of catheter ablation following the first diagnosis of HF and subsequent clinical outcomes in patients with established AF.</p><p><strong>Methods: </strong>We performed a retrospective propensity-score-matched cohort study using the TriNetX Research Network. Adults (≥18 years) with AF who subsequently developed HF and underwent catheter ablation were included. The primary analysis compared ablation from day 1 through 3 months after HF diagnosis with ablation at least 91 days after HF diagnosis. Propensity-score matching yielded 2,570 patients in each group. Outcomes were assessed for 2 years after ablation and included all-cause mortality, electrical cardioversion, emergency department or inpatient encounters, and HF exacerbation. A 1-year timing threshold and analyses stratified by recorded left ventricular ejection fraction were examined as sensitivity analyses.</p><p><strong>Results: </strong>Mean follow-up was 549.3±253.2 days after early ablation and 534.1±255.3 days after later ablation. Mortality was similar between groups (11.0% vs 10.0%; hazard ratio [HR] 1.078, 95% confidence interval [CI] 0.910-1.276; p = 0.384), as were emergency department or inpatient encounters (66.2% vs 65.6%; HR 1.006, 95% CI 0.940-1.076; p = 0.865). Early ablation was associated with fewer cardioversions (15.0% vs 18.6%; HR 0.788, 95% CI 0.689-0.901; p < 0.001) and fewer HF exacerbation events (39.5% vs 46.0%; HR 0.824, 95% CI 0.758-0.896; p < 0.001). The 1-year timing analysis showed a similar pattern for cardioversion and the HF exacerbation.</p><p><strong>Conclusions: </strong>Among patients with AF and HF who ultimately underwent ablation, ablation within 3 months of HF diagnosis was associated with fewer subsequent cardioversions and HF exacerbations than ablation performed from day 91 onward. However, there was no significant difference in mortality between the two cohorts. These findings identify the first months after HF diagnosis as a clinically relevant period for reassessing rhythm-control strategy and warrant prospective evaluation of ablation timing after HF recognition.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168659","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":"Association Between Baseline Cognitive Impairment and Atrial Fibrillation Recurrence After Catheter Ablation.","authors":"Hongwu Dong, Qiannan Ying, Le Zhou, Liu He, Chenxi Jiang, Deyong Long, Changsheng Ma","doi":"10.1111/pace.70453","DOIUrl":"https://doi.org/10.1111/pace.70453","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is common among patients with atrial fibrillation (AF), yet its prognostic significance in the context of catheter ablation remains unclear.</p><p><strong>Aims: </strong>We aimed to investigate whether baseline cognitive impairment, assessed by the Montreal Cognitive Assessment (MoCA), was associated with post-ablation AF recurrence.</p><p><strong>Methods: </strong>Based on the China-AF Registry, we identified 2692 patients with nonvalvular AF who underwent index catheter ablation and had baseline MoCA assessments from 2022 to 2024. Patients were stratified into mild cognitive impairment (MCI, MoCA ≤ 26) and normal cognition (MoCA > 26) groups. The primary outcome was AF recurrence beyond the blanking period. The secondary outcome was a composite of all-cause death, ischemic stroke, and major bleeding. To adjust for confounding factors, we applied inverse probability of treatment weighting (IPTW) methodology. Weighted Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs).</p><p><strong>Results: </strong>After IPTW adjustment, all baseline covariates were well balanced (all standardized mean differences < 0.03). Over a median follow-up of 218 days (IQR, 192-376), the MCI group had a significantly higher risk of AF recurrence (aHR 1.48; 95% CI, 1.27-1.73; p  <  0.001). The composite secondary endpoint did not demonstrate a statistically significant between-group difference (aHR, 1.05; 95% CI, 0.25-4.52; p = 0.945). The association between baseline MCI and AF recurrence was consistent across all prespecified subgroups (all p for interaction > 0.05).</p><p><strong>Conclusion: </strong>In this large prospective registry study, an independent association was observed between baseline cognitive impairment and an elevated risk of post-ablation AF recurrence. Cognitive assessment may be useful for risk stratification but requires external validation.</p><p><strong>Clinical trial registration: </strong>Clinicaltrials.gov Identifier: NCT06987825.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170587","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":"Blanking Period after Atrial Fibrillation Catheter Ablation: A Systematic Review and Meta-Analysis.","authors":"David T Zhang, Sakshum Chadha, Suraj S Patel, Kevin Melcer, Abhijeet Singh, Ibrahim O Almasry, Roger Fan, Eric J Rashba","doi":"10.1111/pace.70467","DOIUrl":"https://doi.org/10.1111/pace.70467","url":null,"abstract":"<p><strong>Background: </strong>Atrial arrhythmias that recur within the first 3 months after atrial fibrillation (AF) catheter ablation are conventionally attributed to a \"blanking period\" and not classified as procedural failure. Accumulating evidence suggests that such early recurrences of atrial tachyarrhythmias (ERAT) may instead predict late recurrence, raising concern that the conventional 3-month window overestimates the duration during which recurrences are benign.</p><p><strong>Objective: </strong>To assess the association between ERAT during each of the first 3 months after AF catheter ablation and late recurrence of atrial tachyarrhythmias (LRAT), and whether this association differs by ablation energy source.</p><p><strong>Methods: </strong>We searched Ovid MEDLINE, Embase, and Web of Science without restriction on date or publication status for studies of AF catheter ablation reporting ERAT during defined intervals of the blanking period, stratified by subsequent LRAT status. Ablation energy sources included radiofrequency, cryoballoon, and pulsed field. The exposure was ERAT during the first, second, and third months after ablation, and the outcome was LRAT. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models.</p><p><strong>Results: </strong>Twelve studies comprising 7,751 patients (2,505 with LRAT, 5,246 without) were included. Mean follow-up was 22.0 months, mean age 60.7 years, 25.8% were women, 52.5% had paroxysmal AF, mean CHA₂DS₂-VASc score was 2.1, mean left atrial diameter 42.6 mm, and mean left ventricular ejection fraction 58.1%. ERAT was associated with subsequent LRAT, and the strength of this association increased across the blanking period: month 1 (12 studies; OR 1.76, 95% CI 1.01-3.08; p = 0.05), month 2 (10 studies; OR 3.46, 95% CI 2.15-5.57; p < 0.001), and month 3 (10 studies; OR 21.4, 95% CI 10.9-42.2; p < 0.001). The graded association was reproduced within the radiofrequency and cryoballoon subgroups.</p><p><strong>Conclusion: </strong>ERAT was associated with subsequent LRAT throughout the blanking period, with a graded relationship that strengthened month by month and was strongest in the third month. These findings support a blanking period shorter than the conventional 3 months.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171388","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":"Left Atrial Appendage Occlusion vs Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation: A Meta-Analysis.","authors":"Ahmed Nazmy, Alaa Abdrabou Abouelmagd, Ahmed Sobhy, Mennatullah Ashour, Hassan El-Shirbiny, Moneeb Khalaph, Ahmed Yasser Shaban, Mahmoud Nazmy, Amroos Shabaan, Abdullah Farahat Elbanna, Abdelrahman Hafez, C Michael Gibson","doi":"10.1111/pace.70465","DOIUrl":"https://doi.org/10.1111/pace.70465","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage occlusion (LAAO) has emerged as a non-pharmacological alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). Following the publication of recent CHAMPION-AF and CLOSURE-AF trials, an updated synthesis of evidence is warranted to clarify the long-term comparative efficacy and safety of LAAO versus OAC in patients with AF.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing LAAO with OAC in adults with AF. A comprehensive search of major databases was performed from inception to April 2026. The primary efficacy outcomes were major adverse cardiovascular events (MACE) and stroke. The primary safety outcome was non-procedure-related bleeding. Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Six RCTs including 7,004 patients (3,681 LAAO; 3,323 OAC) were analyzed. No statistically significant difference was observed for MACE (7.5% vs 6.9%; RR 1.03, 95% CI 0.79-1.34) or stroke (3.7% vs 3.2%; RR 1.07, 95% CI 0.80-1.43). LAAO was associated with a significantly lower risk of non-procedure-related bleeding (9.8% vs 16.7%; RR 0.63, 95% CI 0.52-0.77), corresponding to an absolute risk reduction of 6.9% and an approximate number needed to treat of 15 based on crude pooled event rates over the observed trial follow-up. Trial sequential analysis indicated that the accumulated evidence for MACE and stroke remained inconclusive. Comparator-type subgroup analyses showed no significant interaction for MACE (p = 0.67) or stroke (p = 0.81) between contemporary predominantly-DOAC and VKA comparator trials.</p><p><strong>Conclusions: </strong>LAAO was associated with lower non-procedure-related bleeding, while no statistically significant differences were observed for MACE or stroke. The available efficacy evidence remains inconclusive regarding equivalence or non-inferiority, and larger trials are needed. These findings support individualized consideration of LAAO when the long-term bleeding burden of anticoagulation is clinically important.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149272","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":"Atrial Fibrillation in Patients With Pectus Excavatum: Clinical Characteristics, Management, and Outcomes.","authors":"Eiad Habib, Arshad Mohammed, Michael B Gotway, Alyssa Wallace, Hussein Abdulnabi, Juan F Rodriguez-Riascos, Amal Youssef, Humam Abo Abdullah, Laura Koepke, Nour Odeh, Cecilia Villa Etchegoyen, Ramzi Ibrahim, Mahmoud Abdelnabi, Christopher Kanaan, Abdulrahman Senjab, Juan Maria Farina, Dan Sorajja, Hicham El Masry, Dawn Jaroszewski, Komandoor Srivathsan","doi":"10.1111/pace.70462","DOIUrl":"https://doi.org/10.1111/pace.70462","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pectus excavatum (PE), the most common congenital chest wall deformity, has known associations with connective tissue disorders and may lead to cardiopulmonary impairment; however, its relationship with atrial fibrillation (AF) remains underexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aimed to describe the frequency, clinical characteristics, and management of AF within an institutional cohort of patients with PE, and to determine whether the outcomes observed in clinically distinct subgroups persisted after adjustment for baseline risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a retrospective cohort study design. Patients with both PE and documented AF between January 1, 1990, and November 10, 2024, were included. Clinical, echocardiographic, and therapeutic data were collected. Bleeding and thromboembolic outcomes were evaluated using multivariable logistic regression adjusted for age, sex, CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc score, and anticoagulant class, and the surgically treated subgroup was additionally compared using propensity score matching.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 11,578 patients with PE, 1309 (11.3%) had AF. Of those who had AF, mean age was 66.9 years; 54% were female, and 83% had paroxysmal AF. The mean CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc and HAS-BLED scores were 2.8 and 1.9, respectively. Thromboembolic events occurred in 196 (15%) patients, most commonly stroke (11%), followed by pulmonary embolism (4%) and deep venous thrombosis (4%). Bleeding events occurred in 313 patients (24%), most commonly hematuria (12%), gastrointestinal bleed (11%), epistaxis (5%), and intracranial hemorrhage (1%). Seventy-two patients (6%) underwent the Nuss procedure and were younger (45.3 vs. 68.2 years, p &lt; 0.001), predominantly male (65%), and had lower risk scores compared to the non-Nuss cohort. Patients who underwent the Nuss procedure had significantly fewer bleeding events (5.6% vs. 25%, p &lt; 0.001) with similar thromboembolic rates. The pectus severity index, available in the 370 patients who underwent dedicated radiologic review, was not associated with bleeding (adjusted OR 0.89, 95% CI 0.75-1.05). The difference in bleeding by surgical status persisted after multivariable adjustment (adjusted OR 0.28, 95% CI 0.10-0.79) and after propensity score matching (5.6% vs. 16.7%, p = 0.030).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;AF was identified in approximately one in nine patients within this single-institution cohort of adults with PE, with paroxysmal AF representing the predominant subtype. Patients who had undergone surgical repair demonstrated a lower incidence of bleeding events than anticipated based on their baseline risk profile; however, given the limited number of events observed, this finding should be interpreted with caution and requires validation in larger studies. In the absence of a non-PE comparator group, these data are insufficient to determine whether PE independently confe","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122966","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":"Device-Sparing Posteroseptal Trans-Tricuspid Lead Implantation After Tricuspid TEER: A Three-Case Device Rounds Report.","authors":"Georgios E Papadopoulos, Ilias Ninios, Sotirios Evangelou, Apostolia Marvaki, Maria Kalaitzoglou, Andreas Ioannides, Vlasis Ninios","doi":"10.1111/pace.70463","DOIUrl":"https://doi.org/10.1111/pace.70463","url":null,"abstract":"<p><p>Transvenous right ventricular lead implantation after tricuspid transcatheter edge-to-edge repair (T-TEER) may be challenging because of potential interaction with implanted repair devices, grasped leaflets, or the repaired coaptation zone. We describe three patients requiring transvenous pacemaker or implantable cardioverter-defibrillator implantation after T-TEER with TriClip or PASCAL systems. In each case, the posterior-most T-TEER device was used as a fluoroscopic landmark to guide lead passage inferior and posterior to the device toward an unobstructed posteroseptal residual orifice. Pacemaker leads were delivered using catheter-and-wire crossing followed by advancement of a long slittable sheath, whereas the defibrillator lead required direct shaping and fluoroscopic manipulation because of sheathlead incompatibility. Implantation was successful in all three patients. During 612 months of follow-up, tricuspid regurgitation remained mild or trace, mean transtricuspid gradients ranged from 1.8 to 2.1 mmHg, and no echocardiographic leadleaflet or leaddevice interaction or lead-related complications were observed. This fluoroscopy-guided, device-sparing strategy may represent a practical option when transvenous right ventricular lead implantation is clinically necessary after T-TEER.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122952","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":"Contemporary Advances of Leadless Pacing and Conduction System Pacing in Children With Congenital Heart Disease.","authors":"Yu-Ting Xia, Tong Liu, Song Yan, Yang Zhang, Jin Liu, Li Wei","doi":"10.1111/pace.70452","DOIUrl":"10.1111/pace.70452","url":null,"abstract":"<p><p>The management of bradyarrhythmias requiring permanent pacing in pediatric patients and those with congenital heart disease (CHD) remains uniquely challenging due to continuous somatic growth, complex cardiac anatomy, limited vascular access, and long-term risks associated with conventional cardiac implantable electronic devices. Traditional transvenous endocardial and surgical epicardial pacing systems are associated with high rates of lead failure, venous occlusion, infection, and ventricular dyssynchrony. Leadless pacemakers and conduction system pacing have emerged as promising alternatives that overcome many of these historical limitations. This review provides a comprehensive, updated overview of the technical principles, clinical applications, advantages, limitations, and appropriate patient selection strategies for these two innovative modalities in the pediatric and CHD population. Critical clarifications are provided regarding venous access requirements, age-adjusted interpretation of QRS duration, ventricular dyssynchrony evaluation, and indications for device therapy according to pediatric-specific guidelines rather than adult-derived criteria. Clinical decision-making is integrated into a structured framework based on age, body size, clinical symptoms, ventricular synchrony, and arrhythmic risk stratification.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122910","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}