Pacing and clinical electrophysiology : PACE最新文献

{"title":"Quantitative UHF-ECG Assessment of Pacing-Induced Ventricular Activation: Comparison of LBBAP and RV Septal Pacing.","authors":"Talgat K Yessenov, Telman Z Seisembekov, Ayan Nurkesh, Madi Malik, Zulfiya A Utupova, Sholpan M Kozhabay","doi":"10.1111/pace.70284","DOIUrl":"https://doi.org/10.1111/pace.70284","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849359","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":"Zero-Fluoroscopy Ablation Methods for Atrial Fibrillation: A Systematic Review and Meta-Analysis.","authors":"Marwan Shawki, Ramzi Perdana Ilyas, Karanjeet Chauhan, Thalys Sampaio Rodrigues, Sarah Luna Nabhani, Gareth Wynn","doi":"10.1111/pace.70277","DOIUrl":"https://doi.org/10.1111/pace.70277","url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849327","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 Closure Complicated by Spinal Epidural Hematoma and Device-Related Thrombosis: A Case Report.","authors":"Shufang Wu, Qiqi Jin, Shanjiang Chen, Jianjian Yang","doi":"10.1111/pace.70268","DOIUrl":"https://doi.org/10.1111/pace.70268","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case summary: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849343","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":"Werner Irnich: Pioneer in the Development of the Dual-Chamber Pacemaker-An Obituary.","authors":"Bernd Lemke","doi":"10.1111/pace.70269","DOIUrl":"https://doi.org/10.1111/pace.70269","url":null,"abstract":"<p><p>Fifty years ago, Werner Irnich presented the concept of an optimal pacemaker capable of responding appropriately to various cardiac arrhythmias and perceptual disturbances, and intended to be used in 85% of patients. With this concept, Irnich was far ahead of his time. His proposed circuitry for AV block and atrial fibrillation, as well as his suggestions for antitachycardia pacing and interference detection, were visionary. In the field of rate-adaptive pacing, he introduced AV-time control, the first closed-loop system. Werner Irnich represents the close connection between engineers and physicians in the field of cardiac electrotherapy. His theoretical work on the chronaxie rheobase and the electrode surface, confirmed by experimental data, still forms the basis of modern electrical stimulation today. The most extensive data on the interference immunity of electronic implants comes from his laboratory. In addition to his membership in numerous scientific societies, Werner Irnich served as Senior Editor of the international journal Pacing and Clinical Electrophysiology (PACE) from 1978 to 2013. He passed away on December 2, 2023, at the age of 89, leaving behind his wife Hanni, five children, and twelve grandchildren. We will always remember him with gratitude and deep appreciation for his contributions to cardiac electrostimulation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826354","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 Value of Inter-Lesion Time in Linear Lesion Formation Across Varying Catheter Angles and Inter-Lesion Distances.","authors":"Yuko Matsui, Satoshi Higuchi, Shohei Kataoka, Masayuki Sakai, Kensuke Kikuchi, Shonosuke Watanabe, Kunihiro Kani, Shun Hasegawa, Kyoichiro Yazaki, Daigo Yagishita, Morio Shoda, Junichi Yamaguchi","doi":"10.1111/pace.70272","DOIUrl":"https://doi.org/10.1111/pace.70272","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826364","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":"Anticoagulation for Incident Atrial Fibrillation/Flutter Following Surgical Left Atrial Appendage Occlusion and CABG.","authors":"Vivek Bhat, Bharat Rawlley, Kartik Gupta, Subaina Khalid, Karthikk Murali, Debanik Chaudhuri","doi":"10.1111/pace.70209","DOIUrl":"10.1111/pace.70209","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"660-664"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470838","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":"Distinct Automaticity and Excitability Between Radiofrequency and Cryoballoon Ablation in Paroxysmal Atrial Fibrillation.","authors":"Xiaohong Jiang, Guanjie Zhao, Qi Jiang, Weizhu Ju, Gang Yang, Mingfang Li, Kai Gu, Zidun Wang, Hailei Liu, Chang Cui, Cheng Cai, Hongwu Chen, Minglong Chen","doi":"10.1111/pace.70142","DOIUrl":"10.1111/pace.70142","url":null,"abstract":"<p><strong>Background: </strong>Cryoballoon ablation (CBA) has been shown as an effective alternative strategy to radiofrequency ablation (RFA) for the treatment of paroxysmal atrial fibrillation (PAF), with comparable efficacy and safety. However, the electrophysiological properties in pulmonary veins (PVs) after CBA and RFA are not well understood. This study compares these characteristics in PAF patients.</p><p><strong>Methods: </strong>Consecutive patients with PAF undergoing initial catheter ablation were prospectively randomized to CBA (N = 50) or RFA (N = 50) for PV isolation (PVI). Each PV's automaticity and excitability were assessed. Follow-up for atrial tachyarrhythmia recurrence at 3, 6, and 12 months was monitored via electrocardiogram/Holter.</p><p><strong>Results: </strong>A total of 100 patients were randomized (mean age of 62 ± 10 years). After initial PVI, 33 (66%) patients in the RFA group retained PV automaticity, compared to 17 (34%) patients in the CBA group (p = 0.027). The number of PVs exhibiting stable automaticity was significantly higher in the RFA group compared with the CBA group (51/198 vs. 19/197, p < 0.0001). Ipsilateral PV crosstalk was more common in the RFA group (7/17 vs. 0/2, p = 0.5088). Moreover, low-frequency pacing revealed local capture in 46% of the RFA group versus 2% of the CBA group (p < 0.0001). Fluoroscopy time was shorter with RFA (p = 0.0003), but ablation time was longer (p < 0.0001). Over an average of 13-month follow-up, atrial tachyarrhythmia recurrence rates were similar between groups.</p><p><strong>Conclusions: </strong>Automaticity and excitability within PVs were more prevalent in the RFA group than the CBA group after AF ablation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"626-635"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047699","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":"Delayed CAVB After SP Ablation for AVNRT: Mechanistic Insights Into FP Injury and Pacing Decision-Making.","authors":"Nobuhiro Honda, Kiyohiro Ogawa, Kotaro Tasaki, Mio Hino, Taiki Kodama, Seigo Masuda","doi":"10.1111/pace.70158","DOIUrl":"10.1111/pace.70158","url":null,"abstract":"<p><p>As standard therapy for atrioventricular nodal re-entrant tachycardia (AVNRT), radiofrequency ablation of the antegrade slow pathway (SP) is associated with a low risk of AV block. Delayed complete AV block (CAVB), however, is a rare but clinically challenging complication, particularly concerning permanent pacemaker decision-making. A 79-year-old man with pre-existing first-degree AV block developed delayed CAVB 1 day after successful SP ablation for typical AVNRT. Transient PR interval shortening immediately post-ablation preceded progression to high-grade AV block. Subsequently, AV conduction gradually recovered without permanent pacemaker implantation, as confirmed using serial electrocardiography, treadmill exercise testing, and repeat electrophysiological studies. Electrophysiological evaluation showed impaired antegrade fast pathway (FP) conduction with complete absence of retrograde ventriculoatrial conduction, suggesting differential involvement of FP fibers. Delayed AV block after SP ablation may be reversible, particularly when preceded by PR interval shortening and when AV conduction improves under exercise or pharmacological stress. Careful functional assessment of AV conduction is needed before committing to permanent pacemaker implantation, as delayed AV block may reflect indirect and potentially reversible FP injury.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"610-617"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146184218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Esophagus Spared During Pulsed Field Ablation?","authors":"Antonio Di Monaco, Antonio Fasano, Angiolo Farina, Fabio Rosso, Massimo Grimaldi","doi":"10.1111/pace.70216","DOIUrl":"10.1111/pace.70216","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"665-668"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470823","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":"Combined Percutaneous Mechanical Aspiration and Transvenous Lead Extraction in CIED-Related Endocarditis: A Case Report.","authors":"Augustijn Mortele, Joost Kager, Johan Ghekiere, Reshma Amin, Sander Trenson, Jean-Benoît le Polain de Waroux","doi":"10.1111/pace.70136","DOIUrl":"10.1111/pace.70136","url":null,"abstract":"<p><strong>Introduction: </strong>Current guidelines recommend complete removal of a cardiac implantable electronic device (CIED) in infective endocarditis (IE), with surgical extraction indicated for large vegetations (> 20-25 mm).</p><p><strong>Case: </strong>We report a 68-year-old patient with CIED-related IE and a 3 × 3.5 cm lead vegetation successfully treated by percutaneous mechanical aspiration (PMA) using the FlowTriever system, followed by transvenous lead extraction (TLE). The combined approach achieved complete removal without complications or recurrence.</p><p><strong>Conclusion: </strong>This case highlights PMA as a feasible, less invasive alternative to surgery in selected high-risk patients, enabling safe TLE by reducing vegetation size and embolic risk.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"602-605"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968280","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}