Pacing and clinical electrophysiology : PACE最新文献

{"title":"Cardioneuroablation for the Treatment of Vagal Mediated Ventricular Fibrillation in Short QT Syndrome, Case Report.","authors":"Hamza Hamayel, Fateh Awwad, Yunis Daralammouri, Sajed Majadla, Nidal Sharan, Mohammed Sameer Dwikat, Majed Othman, Ibrahim Marai","doi":"10.1111/pace.70018","DOIUrl":"10.1111/pace.70018","url":null,"abstract":"<p><p>Augmented vagal effect may be the trigger of ventricular arrhythmia in Short QT syndrome (SQTS). We offer a novel option for refractory cases. This is a 28-year-old male patient who experienced recurrent ICD shocks due to ventricular fibrillation (VF) episodes preceded by enhanced vagal tone. Conventional treatment failed to suppress ventricular arrhythmia. Cardioneuroablation was performed to attenuate vagal response, which ultimately suppressed ventricular arrhythmia. Cardioneuroablation may be an alternative option for vagal mediated ventricular arrhythmia in patients with SQTS refractory to conventional treatments.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1010-1013"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747050","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":"Incidence and Influencing Factors for Steam Pops in Cardiac Ablations: A Systematic Review.","authors":"Khaled Elenizi, Rasha Alharthi","doi":"10.1111/pace.70022","DOIUrl":"10.1111/pace.70022","url":null,"abstract":"<p><strong>Background: </strong>Steam pops (SPs) during cardiac ablations have emerged as a notable phenomenon with potential implications for procedural safety and efficacy. This is the first review of SPs, which aims to explore the current understanding of SPs. The review investigates their incidence, associations, predictors, clinical significance, and management strategies. Presently, the factors that give rise to SPs have not been completely understood, and the root cause of SPs remains elusive. To achieve this goal, the study conducted a comprehensive review of existing research on SPs in cardiac ablation procedures to ascertain the prevalence and predictors of SPs.</p><p><strong>Methods: </strong>The research involved an extensive search of databases from their inception until April 2024 to investigate the prevalence of SPs during cardiac ablation procedures in humans. The primary objective of this study was to gather patient demographics, incidence rates, and potential risk factors and predictors that could contribute to the occurrence of SPs and determine any significant correlations between them. The data collected were thoroughly reviewed to identify any significant associations between the various risk factors, predictors, and the incidence of SPs.</p><p><strong>Results: </strong>A comprehensive review of literature sourced from EMBASE and PubMed identified 25 relevant studies focused on the incidence and clinical significance of steam pops (SPs) during catheter ablation procedures. The studies reported varying rates of SPs, ranging from 0% to 26%, with the highest incidence observed in atrial fibrillation (AFib) and ventricular ablation cases. The association between SPs and factors such as catheter type, irrigation methods, and monitoring parameters was assessed. Notably, advanced catheter technologies, such as the QDOT MICRO and THERMOCOOL SMARTTOUCH, demonstrated a significant reduction in SP occurrences. Additionally, the analysis highlighted the role of temperature control and contact force in minimizing the risk of SPs, with temperature-controlled ablation (TCA) generally leading to fewer SPs compared to power-controlled ablation (PCA). Despite the low incidence of severe complications, the review underscores the importance of careful monitoring of impedance and real-time feedback during ablation to ensure patient safety.</p><p><strong>Conclusion: </strong>SPs are not uncommon during ablation procedures with irrigated catheters. Caution is required to avoid temperature feedback issues. Advanced catheters are associated with a reduced incidence of steam pops. The risks can be minimized by decreasing energy settings and monitoring impedance changes.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"941-952"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763051","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":"Hitting the Wall: The Hidden Challenge of 2:1 Block in Pacemaker Patients.","authors":"Marc Strik, Sylvain Ploux, Anand Thiyagarajah, Lars van Krimpen, Pierre Bordachar","doi":"10.1111/pace.70006","DOIUrl":"10.1111/pace.70006","url":null,"abstract":"<p><strong>Introduction: </strong>Dual-chamber pacemakers incorporate proprietary algorithms to optimize atrioventricular (AV) synchronization and prevent pacemaker-mediated arrhythmias. Patients have recently presented to our center with severe exercise intolerance due to the early onset of 2:1 AV block caused by Biotronik's Auto-PVARP and 2:1 Lock-in protection algorithms. This study evaluates the relationship of these algorithms to low 2:1 block rates in a large cohort of remotely monitored pacemaker patients.</p><p><strong>Methods: </strong>We troubleshooted the patients with symptomatic exercise intolerance. We then performed an observational study using remote monitoring data from 895 patients implanted with Biotronik pacemakers, programmed in DDD(R) mode with the Auto-PVARP algorithm activated. We analyzed PVARP settings, 2:1 block rates, and their relationship with age-predicted maximal sinus rates.</p><p><strong>Results: </strong>Among the 895 remotely monitored patients, the majority had significantly prolonged PVARP settings, lowering their 2:1 block rate. At the most recent transmission, only 37% had a PVARP ≤225 ms, while 63% had longer values (275-375 ms), leading to lower 2:1 block thresholds. The 2:1 block rate was below the age-predicted maximal sinus rate in 48% of patients, suggesting a high risk of pacing-induced exercise limitations. The prolonged PVARP was largely driven by Auto-PVARP extensions, often without documented pacemaker-mediated tachycardia (PMT). These findings indicate that a significant proportion of pacemaker-dependent patients may unknowingly experience pacing-related exercise intolerance.</p><p><strong>Conclusion: </strong>The Biotronik Auto-PVARP algorithm frequently extends the refractory period, lowering the threshold for 2:1 block and potentially limiting exercise capacity in active patients. Disabling Auto-PVARP and setting a fixed, shorter PVARP may improve exercise tolerance.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"953-958"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487749","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":"Development and Validation of a Mortality Prediction Model for Left Ventricular Thrombus.","authors":"Song Lei, Chenyu Yu, Li Li, Mei Liu, Mou Yang, Hongde Hu","doi":"10.1111/pace.70014","DOIUrl":"10.1111/pace.70014","url":null,"abstract":"<p><strong>Objective: </strong>Left ventricular thrombus (LVT) is a severe complication associated with increased risks of systemic embolism and mortality. Despite advancements in anticoagulant therapy, optimal management strategies and risk factors for all-cause mortality remain unclear. This study aims to develop a predictive model to assess mortality risk in LVT patients and guide clinical decision-making.</p><p><strong>Methods and results: </strong>This retrospective cohort study included LVT patients diagnosed at West China Hospital (June 2018-June 2023). Patients were classified into survival and mortality groups based on all-cause mortality during follow-up. A total of 459 patients were included, randomly divided into training (n = 322) and validation (n = 137) sets. Logistic regression analysis identified seven independent predictors of mortality, which were used to construct a nomogram-based risk prediction model. The model demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.846 in the training set and 0.791 in the validation set. Key mortality predictors included elevated B-type natriuretic peptide (BNP) (OR 3.359, 95% CI 1.827-6.176, p = 0.0001), lower albumin levels (OR 0.930, 95% CI 0.882-0.981, p = 0.0077), absence of antithrombotic therapy (OR 0.468, 95% CI 0.303-0.723, p = 0.0006), and presence of malignant tumors (OR 6.199, 95% CI 1.593-24.129, p = 0.0085).</p><p><strong>Conclusion: </strong>A novel mortality prediction model for LVT patients was developed, offering a valuable tool for risk assessment and treatment optimization. This model provides a valuable tool for risk assessment and treatment optimization in Asian populations, particularly in China. Further validation is required to confirm its clinical utility.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1024-1036"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802409","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":"Spike After Spike: Unraveling the Mystery of Pacing Failure.","authors":"Avishkar Agrawal, Sumit Kumar, Siddharthan Deepti, Neeraj Parakh, Gautam Sharma, Nitish Naik","doi":"10.1111/pace.70027","DOIUrl":"10.1111/pace.70027","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"981-984"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819081","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 Recurrence After Catheter Ablation: The Puzzle We Have and the Pieces We Need.","authors":"Panayotis K Vlachakis, Anastasios Apostolos, Panagiotis Theofilis, Paschalis Karakasis, Ioanna Koniari, Athanasios Kordalis, George Leventopoulos, Maria Drakopoulou, Ioannis Leontsinis, Dimitrios Tousoulis, Konstantinos Toutouzas, Konstantinos Gatzoulis, Skevos Sideris, Costas Tsioufis","doi":"10.1111/pace.15221","DOIUrl":"10.1111/pace.15221","url":null,"abstract":"<p><p>Atrial fibrillation (Afib) recurrence following catheter ablation (CA) remains a significant challenge within the electrophysiology community, potentially driven by complex mechanisms and diverse patient characteristics. Although multiple predictors of recurrence have been investigated, only a limited number have been consistently validated across studies, suggesting uncertainty in their predictive reliability. Advances in ablation techniques, such as pulsed-field ablation, may offer improved outcomes compared to traditional methods, though their long-term efficacy awaits further confirmation. Aggressive management of modifiable risk factors, alongside selective pharmacotherapies, appears to enhance ablation success, yet optimal strategies remain under exploration. Post-recurrence interventions, such as timely cardioversion or early reablation, could improve rhythm control, but their benefits depend on refined patient selection and timing. Emerging technologies, including artificial intelligence and advanced mapping, hold potential to refine risk stratification and procedural precision, pending robust validation. Comprehensive approaches integrating lifestyle interventions, procedural innovations, and individualized care seem essential for optimizing Afib management. Addressing these gaps may provide the critical pieces needed to solve the puzzle of Afib recurrence after CA.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"985-998"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259932","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":"Non-Occlusive Separate Freezing for Cryoballoon Pulmonary Vein Isolation to the Large Pulmonary Vein.","authors":"Hirofumi Arai, Yuichiro Sagawa, Takatoshi Shigeta, Kazuya Murata, Koji Sudo, Yumi Yasui, Atsuhito Oda, Manabu Kurabayashi, Kaoru Okishige, Tetsuo Sasano, Yasuteru Yamauchi","doi":"10.1111/pace.70025","DOIUrl":"10.1111/pace.70025","url":null,"abstract":"<p><strong>Background: </strong>Cryoballoon pulmonary vein (PV) isolation (PVI) requires PV occlusion, which can be challenging to the large PV. The non-occlusive separate freezing, which involves freezing the superior and inferior portions of the PV ostium without complete occlusion, is often useful in these situations. This study aimed to evaluate the efficacy and long-term results of the non-occlusive separate freezing technique and compare the treatment details of POLARx and Arctic Front Advance Pro (AFA-Pro).</p><p><strong>Methods: </strong>Patients who underwent cryoballoon PVI using the non-occlusive separate freezing between September 2019 and April 2023 in our institution were analyzed and followed up for 1 year. Success rates of PVI by non-occlusive separate freezing and treatment outcomes were compared between POLARx and AFA-Pro. The 1-year arrhythmia-free survival was also evaluated.</p><p><strong>Results: </strong>Overall, 135 PVs were analyzed (POLARx, n = 63; and AFA-Pro, n = 72). The success rates of PVI for the POLARx and AFA-Pro were 55/63 (87.3%) and 52/72 (72.2%), p = 0.04. The nadir temperatures for the POLARx and AFA-Pro were -52.2 ± 4.7°C and -42.4 ± 7.4°C, p < 0.001. No phrenic nerve injury occurred in either group, but two cases of gastric hypomotility were observed using POLARx. The 1-year arrhythmia-free survival rates for POLARx and AFA-Pro were 86.4% and 81.2%, p = 0.47.</p><p><strong>Conclusions: </strong>The success rate of PVI using the non-occlusive separate freezing technique was approximately 80% and was significantly higher with POLARx than with AFA-Pro. The 1-year arrhythmia-free survival rate was not significantly different.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1014-1023"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765912","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":"Long-Term Outcomes of Catheter Ablation in Heart Failure With Reduced Ejection Fraction Patients With Atrial Fibrillation.","authors":"Mohammed Nor, Olayiwola Bolaji, Ali Bilal, Mohamed S Mahmoud, Abdirahman Wardhere, Jarrett Kelley, Chafik Assal","doi":"10.1111/pace.70017","DOIUrl":"10.1111/pace.70017","url":null,"abstract":"<p><strong>Background: </strong>While catheter ablation (CA) has emerged as an effective treatment for symptomatic atrial fibrillation (AF), its impact on long-term clinical outcomes in patients with concomitant heart failure with reduced ejection fraction (HFrEF) remains uncertain.</p><p><strong>Objective: </strong>This study aimed to evaluate the clinical outcomes of CA versus conventional therapy in patients with HFrEF and AF.</p><p><strong>Methods: </strong>We utilized data from the TriNetX US Collaborative Network (January 2014-December 2024) with a 3-year follow-up period. Patients aged ≥18 years with HFrEF (EF < 40%) and AF were categorized into two cohorts: those received CA versus conventional therapy. Propensity score matching was performed to minimize selection bias. The primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalization, recurrent AF, and heart failure (HF) hospitalization.</p><p><strong>Results: </strong>After propensity score matching, 64,743 patients remained in each cohort. The mean age was 73.4 ± 11.4 years in the CA cohort and 73.5 ± 11.5 years in the control cohort (p = 0.109). CA was associated with reduced all-cause mortality (HR = 0.46, 95% CI: 0.43-0.49, p < 0.001), all-cause hospitalization (HR = 0.94, 95% CI: 0.92-0.95, p < 0.001) and recurrent AF (HR = 0.80, 95% CI: 0.79-0.82, p < 0.001) but higher HF hospitalization (HR = 1.07, 95% CI: 1.06-1.08, p < 0.001) compared to conventional therapy.</p><p><strong>Conclusions: </strong>Our study demonstrated that in patients with AF and HFrEF, CA was associated with significantly reduced all-cause mortality, all-cause hospitalization, and AF recurrence, but an increased risk of HF hospitalization compared to conventional therapy. These findings suggest that CA may provide substantial long-term benefits in this high-risk population, while highlighting the importance of careful patient selection and post-procedural management.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1037-1046"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802411","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":"Joint Pacing and Vascular Intervention for the Management of Cardiac Device Associated Central Venous Obstruction.","authors":"Nadeev Wijesuriya, Helen Sinabulya, Helena Johann-Meyer, Keisha Kellman, Felicity de Vere, Sandra Howell, Alphonsus Liew, Paolo Bosco, Steven A Niederer, Stephen Black, Christopher A Rinaldi","doi":"10.1111/pace.70019","DOIUrl":"10.1111/pace.70019","url":null,"abstract":"<p><strong>Background and aims: </strong>Central venous obstruction (CVO) increases the complexity of pacing interventions, whether it be with device-associated symptomatic superior vena cava syndrome (SVCS), or by impeding new implants. Endovascular treatment involves the joint expertise of both cardiac pacing and vascular specialists. We report the outcomes of such procedures at our institution.</p><p><strong>Methods: </strong>A single-center retrospective observational study, examining outcomes of joint pacing-vascular procedures for CVO. Cases were screened from an existing institutional database.</p><p><strong>Results: </strong>There were 19 total cases. Two were new device implants where the novel \"inside-out\" procedure was utilized to establish access in SVCS, both with no complications. The remainder (n = 17) were transvenous lead extractions plus attempted recanalization of CVO using venoplasty with or without stenting. Transvenous devices were re-implanted in eight patients. Complete procedure success rate was 84%. There were two cases of pericardial effusion requiring pericardiocentesis, resulting in procedure abandonment. There was no in-hospital mortality and no cases of emergency sternotomy. Over mean follow-up of 28 months, 2/6 patients receiving venoplasty (33%) and 2/8 patients receiving stenting (25%) required re-intervention for symptomatic restenosis. Of the patients who were not re-implanted with a transvenous device following initially successful endovascular intervention (6/14), none had recurrence over the follow-up period.</p><p><strong>Conclusion: </strong>Pacing interventions in SVCS carry a significant risk profile, requiring management by experienced operators in high-volume centers to maximize safety. Endovascular interventions have a significant recurrence rate, with up-front stenting potentially being superior. Our data suggests that those without re-implantation of transvenous leads may have better long term outcomes.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"959-966"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763052","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":"Ultrasound Guided Venous Access for Cardiac Devices: Defining Learning Curve for Safety, Efficacy, and Radiation Exposure.","authors":"Anish N Bhuva, Hnin Zaw, Adam Graham, Amal Muthumala, Philip Moore, Mehul Dhinoja","doi":"10.1111/pace.70021","DOIUrl":"10.1111/pace.70021","url":null,"abstract":"<p><strong>Background: </strong>There is limited real-world experience of the learning curve for ultrasound (US) guided axillary venous access for cardiac device implantation, and it is usually performed before cutaneous incision. We investigated the learning curve, radiation exposure, safety, and efficacy of US-guided venous access in standard workflow.</p><p><strong>Methods: </strong>US-guided access was performed by an experienced electrophysiologist with no prior application of the technique by using a standard vascular US probe and minimal modification to workflow. The learning curve was evaluated using access time (needle-to-wire time). Complications were recorded until hospital discharge, and efficacy was defined by procedural success. Radiation dose savings were estimated based on fluoroscopy time for access, and a control group underwent conventional fluoroscopy landmark-guided access (n = 44 punctures).</p><p><strong>Results: </strong>147 US-guided punctures were performed in 74 patients for one (8%), two (71%), or three (17%) leads, or upgrades (4%). Access was successful in 97% (n = 72). There were no access-related peri-procedural complications. First US-guided access time was 30 seconds (interquartile range [IQR]: 17,60), and was similar to fluoroscopy-guided access time (43 seconds, IQR: 24,58; p = 0.45). Access time stabilized after 45 procedures, decreasing from 81 (IQR: 61,90) to 16 seconds (IQR: 10,20) from the first to the last 15 procedures (p < 0.001). 96% (n = 69) did not require fluoroscopy. 4% (n = 3) required 1 second fluoroscopy to confirm wire position after difficult passage. Estimated radiation exposure saving from controls was 30 seconds (IQR: 15,78) of fluoroscopy, resulting in 0.4 (IQR: 0.26,1.7) mGy cumulative skin dose, equivalent to 1.3 (95% confidence interval: 0.26,1.45) patient chest radiograph radiation exposure.</p><p><strong>Conclusion: </strong>US-guided axillary venous access for cardiac device implantation is feasible in a standard workflow and reduces radiation exposure. The learning curve time is acceptable, and the procedure is safe, even during training.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"967-972"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763054","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}