Pacing and clinical electrophysiology : PACE最新文献

{"title":"Outcomes of a Simplified Two-Catheter Approach for Catheter Ablation of SVT in Pediatric Patients.","authors":"Jasmin Dominguez Cervantes, Amjad A Mansour, Daniel Cortez","doi":"10.1111/pace.70458","DOIUrl":"https://doi.org/10.1111/pace.70458","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablations are an established treatment for supraventricular tachycardia (SVT) in pediatric patients with high success and low complication rates typically. This study evaluated the procedural outcomes, safety, and recurrence rates of pediatric patients undergoing SVT ablation using a two-catheter approach.</p><p><strong>Methods: </strong>A retrospective review was performed of 150 pediatric patients who underwent electrophysiology studies and catheter ablation for SVT. All patients were younger than 21 years, with arrhythmia mechanisms including atrioventricular nodal reentrant tachycardia (AVNRT), ectopic atrial tachycardia (EAT), atrial flutter, and other accessory pathway-mediated tachycardias. All electrophysiology (EP) studies and catheter ablations were performed using a two-catheter access approach at the University of California at Davis by a sole operator with typically just a catheter in the coronary sinus and a second linear catheter (right atrial/ ventricular/ His) to start. All patients had follow-up of one year or if recurrence than 1 year from subsequent ablation.</p><p><strong>Results: </strong>Acute procedural success was achieved in all patients. The median age at the time of ablation was 13 years (IQR: 8-16 years). The median weight and height were 53.9 kg (IQR: 34.6-67.6 kg) and 157.3 cm (IQR: 137-170 cm), respectively. No intraprocedural complications were observed, including vascular access complications. Additionally, no postprocedural complications occurred, including pericardial effusion, cardiac tamponade, air embolism, thrombus formation, or heart block. Two patients experienced arrhythmia recurrence within 12 months of follow-up, corresponding to a recurrence rate of 1.3% and an overall success rate of 98.7%. Recurrence occurred in one patient with a Mahaim pathway and one patient with a left posterolateral accessory pathway.</p><p><strong>Conclusion: </strong>A two-catheter access approach may be safely performed with good short-and medium-term outcomes in pediatric patients.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122963","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 Reverse Remodeling by Bachmann's Bundle Pacing With Improved Interatrial Dyssynchrony: Case Series.","authors":"Misaki Naka, Tetsuma Kawaji, Bingyuan Bao, Tomoya Kimura, Shun Hojo, Shintaro Matsuda, Masashi Kato, Takafumi Yokomatsu, Shinji Miki","doi":"10.1111/pace.70261","DOIUrl":"10.1111/pace.70261","url":null,"abstract":"<p><strong>Background: </strong>Bachmann's bundle pacing (BBp) improves interatrial conduction, but its clinical impact on atrial function has not fully established.</p><p><strong>Methods and results: </strong>We report eight cases of attempted BBp. Three cases met BBp electrocardiographic criteria with significant P-wave shortening and P-wave amplitude increase in the inferior leads, resulting in improved left atrial (LA) function (increased a' velocity, decreased E/e', and reduced LA diameter) and heart failure stabilization. Conversely, the remaining five cases failing to achieve significant P-wave changes showed no such improvements.</p><p><strong>Conclusions: </strong>Restoring interatrial conduction through successful BBp may optimize LA performance, potentially offering heart failure stabilization.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1573-1579"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719368","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":"Breaking Frontiers-Leadless Atrial-Ventricular Hybrid Upgrade to Dual Chamber Leadless Pacemaker.","authors":"João Mendes Cravo, Diogo Rosa Ferreira, Ana Abreu Bernardes, Lénia Coelho, Emiliano Manuel Machado, Fausto J Pinto, João de Sousa, Pedro N C Marques","doi":"10.1111/pace.70252","DOIUrl":"10.1111/pace.70252","url":null,"abstract":"<p><strong>Introduction: </strong>Leadless pacemakers (LP) have significantly reduced device-related complications compared with conventional systems, yet limitations in atrial pacing and atrioventricular (AV) synchrony restrict their widespread use.</p><p><strong>Methods and results: </strong>We report an 87-year-old man with a history of stage 5 CKD on haemodialysis with complete AV block and a previously implanted Micra-AV who developed symptomatic sinus node dysfunction. To restore AV synchrony and avoid transvenous implantation, an Abbott AVEIR AR atrial LP was implanted, achieving functional dual-chamber leadless pacing. The procedure had no complications, and the follow-up demonstrated 89% AV synchrony with symptomatic improvement.</p><p><strong>Conclusion: </strong>This case demonstrates the feasibility of achieving a hybrid dual-chamber leadless pacing system from two different manufacturers in selected patients.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1567-1572"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680156","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":"Safety and Efficacy of a Novel Radiofrequency Wire-Based Transseptal Puncture System.","authors":"Fazlullah A Wardak, Antia Garcia Fernandez, John R Paisey, Robert W Bowers, Arthur M Yue, Waqas Ullah","doi":"10.1111/pace.70293","DOIUrl":"10.1111/pace.70293","url":null,"abstract":"<p><strong>Background: </strong>Transseptal puncture (TSP) is a key component of cardiac ablation and structural interventional procedures. Procedural efficacy and safety of the VersaCross TSP platform, a novel blunt radiofrequency (RF)-wire based system, was compared with conventional equipment.</p><p><strong>Methods: </strong>Consecutive patients undergoing TSP with VersaCross or a control group using conventional equipment were studied. Procedures were carried out using fluoroscopy alone or with additional transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance. Procedural metrics including TSP and fluoroscopy times were recorded. Complications, both acute and up to a month post procedure, were included.</p><p><strong>Results: </strong>Two hundred and fifty procedures were included (150 VersaCross, 100 control) in the registry. Of these, 100 consecutive cases (75 VersaCross, 25 control) had prospective data collected for procedural metrics. Between the VersaCross and control cases, there was no difference between echocardiographic use (50 vs. 52%, p = 0.8) or conscious sedation use (53 vs. 55%, p = 0.56). AF ablations predominated in both groups (81% vs. 90%). There was no difference between median TSP or fluoroscopy times for either single or double transseptal access between groups. There were five minor (one momentary AV-block and four acute pericardial effusions not requiring intervention) and two major (cardiac tamponade and hemothorax) complications in the VersaCross group, with two major (cardiac tamponade) complications in the control group.</p><p><strong>Conclusions: </strong>The VersaCross TSP system can be used in a variety of ablation procedures with or without TEE/ICE guidance under conscious sedation or general anesthesia. Compared with conventional TSP technologies, there is no increase in major complications, TSP or fluoroscopy times.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1612-1621"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960658","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 Myocardial Infarction: Global Burden, Predictors, and Prognostic Impact.","authors":"Eddy Xiong, Sandhir B Prasad, John J Atherton, Jason Davis, Paul Martin, Daniel Lancini","doi":"10.1111/pace.70355","DOIUrl":"10.1111/pace.70355","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most prevalent sustained arrhythmia worldwide. Acute myocardial infarction (AMI) is closely intertwined with AF through a bidirectional relationship: pre-existing AF is associated with increased risk of AMI, while AMI predisposes to new-onset atrial fibrillation (NOAF). This narrative review synthesizes evidence on the global burden of AF in the setting of AMI: pre-existing AF, NOAF following AMI, and the prognostic implications of AF in AMI, encompassing the 'past, present and future' of AF in AMI. Pre-existing AF is present in 3%-4% of patients with AMI and has demonstrated an independent association with acute coronary syndromes, mediated by systemic inflammation, prothrombotic states, demand ischemia, and coronary thromboembolism. NOAF complicates 5%-20% of AMI cases, with peak onset within the first six months. Predictive factors include age, comorbidities such as chronic kidney disease, markers of inflammation (including systemic immune-inflammation index and hs-CRP), neurohormonal activation (NT-proBNP), echocardiographic parameters of diastolic dysfunction and left atrial strain, and electrocardiographic features such as QRS fragmentation. Multiple predictive models for NOAF have been developed with varying discriminatory performance. Emerging research suggests that machine learning may provide superior risk stratification, though further study is needed. AF in the context of AMI confers substantially increased risk of mortality, stroke, bleeding, and heart failure, with NOAF showing particularly strong prognostic significance. Improved recognition of predictive markers, alongside development of tailored prognostic models, is essential to guide antithrombotic therapy and optimize outcomes in this high-risk population.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1540-1549"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552101","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":"Clues From the Device: Individualized Programming to Solve a Pacing-Facilitated AVNRT.","authors":"Xiaoli Liu, Peilin Xiao","doi":"10.1111/pace.70416","DOIUrl":"10.1111/pace.70416","url":null,"abstract":"<p><p>A dual-chamber pacemaker patient with sick sinus syndrome presented with a slow, long-RP' tachycardia. Device interrogation revealed that a spontaneous PVC reset the tachycardia, excluding atrial tachycardia. A subsequent atrial paced beat advanced the next QRS, excluding junctional tachycardia and implicating the slow pathway in the reentrant circuit. Diagnosis of AVNRT was confirmed. Shortening the AV delay terminated all episodes. This case demonstrates the diagnostic utility of pacemaker algorithms and the value of individualized programming.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1496-1499"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901837","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":"Reversal of Mechanical Dyssynchrony and Suppression of Atrial and Ventricular Ectopy With Left Bundle Branch Area Pacing.","authors":"Muhammet Dural, Gurbet Ozge Yunus, Istiklal Ozkaya, Ali Tolga Akdoğan, Fatih Enes Durmaz","doi":"10.1111/pace.70249","DOIUrl":"10.1111/pace.70249","url":null,"abstract":"<p><p>Left bundle branch area pacing (LBBAP) is an effective strategy for restoring electro mechanical synchrony; however, its potential to suppress a high burden of concomitant atrial and ventricular ectopy remains to be fully elucidated. We present a 57-year-old male patient with left bundle branch block (LBBB)-induced cardiomyopathy who experienced significant improvement in left ventricular ejection fraction (LVEF) and marked suppression of both premature ventricular contractions (PVCs) and supraventricular extrasystoles (SVEs) after LBBAP. At 6 months of follow-up, LVEF increased to 58%, PVCs decreased to 200 per day, and SVEs disappeared. LBBAP can reverse mechanical dyssynchrony and suppress a high burden of ectopy.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1563-1566"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663464","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":"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":"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":"1647-1653"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","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":"A Standardized Zero-Fluoroscopy, 3D-Guided Workflow for AVNRT Ablation With Same-Day Discharge: PICENO AVNRT Approach.","authors":"Procolo Marchese, Francesca Gennaro, Giovanni Mazzotta, Luigi Cocchiara, Giuseppe Crapisi, Chiara Pratolongo, Dalila Desiro, Francesco Luca Berardini, Karim Shebabeddine, Matteo Mirarchi, Pierfrancesco Grossi","doi":"10.1111/pace.70308","DOIUrl":"10.1111/pace.70308","url":null,"abstract":"<p><strong>Introduction: </strong>Slow-pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT) is highly effective but carries a small risk of atrioventricular block. A fully standardized, safety-driven 3D-guided workflow tailored to AVNRT ablation has not been clearly defined.</p><p><strong>Methods and results: </strong>We retrospectively analyzed 150 consecutive day-hospital patients with invasive electrophysiological confirmation of AVNRT who underwent ablation using the standardized PICENO AVNRT approach between 2017 and 2025. The protocol integrates Koch's triangle pace mapping and voltage-bridge mapping to guide slow-pathway ablation. Acute success was achieved in 100% of patients. No transient or permanent AV block occurred. Fluoroscopy was not required in any case. Mean procedure time was 62 ± 14 min. At 30.5 ± 18.8 months of follow-up, one recurrence (0.7%) was observed.</p><p><strong>Conclusion: </strong>A standardized 3D-guided safety-driven workflow for AVNRT ablation is feasible and reproducible in a day-hospital setting, achieving excellent outcomes while eliminating fluoroscopy because of procedural reliability.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1478-1486"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044960","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":"Remote Monitoring of Implantable Loop Recorders in Syncope Patients: Management of High Volume of Transmissions.","authors":"Antti Oinonen, Eeva Torvinen, A Marjamaa, Toni Jäntti, Mikko Parry, Jarkko Karvonen, Pekka Raatikainen, Markus Sane","doi":"10.1111/pace.70289","DOIUrl":"10.1111/pace.70289","url":null,"abstract":"<p><strong>Background: </strong>Implantable loop recorder (ILR) is among the first line diagnostic tools in patients with unexplained syncope. When ILRs are followed with remote monitoring (RM) diagnosis can be established readily. However, the challenge in RM is the substantial workload related to false positive findings. The aim of this study was to evaluate the impact of symptom base scheduled monitoring (SBSM) on the efficacy and safety on follow-up of patients with unexplained syncope and large number of nonactionable RM transmissions.</p><p><strong>Methods: </strong>The data of all patients (n = 176) with ILR implantation due to unexplained syncope from first of January 2021 to 31st of December 2024 were collected. Symptom based scheduled monitoring (SBSM), where the alert transmissions were replaced by scheduled quarterly and symptom-triggered transmissions, was introduced after 3 months alert-based follow-up in patients with a high burden of nonactionable transmissions.</p><p><strong>Results: </strong>Mean age of the patients was 60 ± 17 years (56% female). ILR monitoring led to diagnosis in 34 % of the patients. Median time to diagnosis was 84 days (18-216 days) and the therapy included a pacemaker or an ICD implantation in 85% of them. SBSM was used in 18% of the patients. It was associated neither with an increased need for emergency room visits (p = 0.6) nor with hospitalization (p = 0.8). With SBMS the number of monthly RM transmissions decreased almost 80% from 1.5 to 0.3 transmission/device (p = 0.001).</p><p><strong>Conclusions: </strong>Our data indicates that the burden related to the non-actionable ILR alerts can be significantly reduced with SBMS without compromising patient safety.</p><p><strong>Capsule summary: </strong>Implantable loop recorders (ILRs) enable prompt diagnosis in patients with unexplained syncope. Unfortunately, they also generate a deluge of false-positive alerts. However, turning off alerts in patients with the highest burden of nonactionable transmissions can reduce the remote-monitoring workload without compromising patient safety.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1604-1611"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960679","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}