Pacing and clinical electrophysiology : PACE最新文献

{"title":"Pacemaker Syndrome: A Narrative Review.","authors":"Muhammad Asad, Kubra Khaliq, Asif Shah, Muhammad Fiaz, Abida Perveen","doi":"10.1111/pace.70361","DOIUrl":"10.1111/pace.70361","url":null,"abstract":"<p><p>Since the first pacemaker implantation in 1958, cardiac pacing has transformed the management of bradyarrhythmias and conduction system disease. Despite major technological advances and the widespread use of dual-chamber and biventricular pacing systems, pacemaker therapy may be complicated by pacemaker syndrome, a clinical entity resulting primarily from atrioventricular (AV) dyssynchrony. Pacemaker syndrome is characterized by a constellation of cardiovascular and neurologic symptoms including fatigue, dyspnea, dizziness, hypotension, palpitations, and neck pulsations. Although initially associated with single-chamber ventricular pacing, it is now recognized that pacemaker syndrome can occur with any pacing modality when inappropriate timing between atrial and ventricular contractions exists. The underlying pathophysiology involves reduced ventricular preload, loss of atrial contribution to cardiac output, retrograde ventriculoatrial conduction, elevated atrial pressures, and abnormal baroreceptor and neurohormonal responses. These mechanisms lead to impaired hemodynamics and a wide spectrum of clinical manifestations, ranging from mild exercise intolerance to overt heart failure and syncope. The reported incidence varies widely, from 2% to 80%, depending on diagnostic criteria and pacing mode, with higher rates observed in ventricular-paced systems. Diagnosis is primarily clinical and requires correlation of symptoms with device function and cardiac rhythm through pacemaker interrogation and electrocardiography. Management focuses on restoring AV synchrony by device reprogramming or upgrading to dual-chamber pacing, along with guideline-directed therapy for associated ventricular dysfunction. Early recognition and intervention are essential, as untreated pacemaker syndrome may lead to persistent ventricular dysfunction, atrial arrhythmias, reduced quality of life, and increased morbidity.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1550-1558"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671971","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 Cardiovascular Outcomes Following New-Onset Arrhythmias During Pregnancy.","authors":"Sanya Dhama, Yong Hao Yeo, Mohammed Uddin, Rhea Dhama, Kamala P Tamirisa","doi":"10.1111/pace.70283","DOIUrl":"10.1111/pace.70283","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmias during pregnancy are increasingly prevalent and associated with acute adverse cardiovascular outcomes, yet their long-term cardiovascular implications remain poorly defined. To address this gap, we conducted a large population-based study to evaluate 5-year cardiovascular outcomes following incident arrhythmias during pregnancy.</p><p><strong>Methods: </strong>Using TriNetX, we conducted a retrospective cohort study of pregnant individuals (≥18 years) admitted for delivery between 2015 and 2020. Patients with new-onset arrhythmias during pregnancy were compared with those without arrhythmias. Outcomes included composite cardiovascular outcomes, incident heart failure (HF), cerebrovascular accident (CVA), and acute myocardial infarction (AMI). Propensity score matching (1:1) was used to adjust for demographic and clinical comorbidities.</p><p><strong>Results: </strong>Among 886,732 deliveries, 8507 patients (0.9%) had incident arrhythmias. After matching, individuals with incident arrhythmias during pregnancy had higher 5-year risks of composite cardiovascular outcomes (risk ratios [RR] 3.82), HF (RR 4.48), CVA (RR 2.04), and AMI (RR 4.80) (all P < 0.01). Associations persisted across age strata, with particularly elevated risks among those ≥35 years.</p><p><strong>Conclusions: </strong>This study, among the first to our knowledge to evaluate long-term cardiovascular outcomes following incident arrhythmias during pregnancy, demonstrates a substantially increased 5-year cardiovascular risk, underscoring the need for extended postpartum cardiovascular surveillance beyond routine follow-up.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1654-1656"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147877215","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":"AV Node Ablation and Conduction System Pacing Versus Biventricular Pacing in Patients With AF and HF.","authors":"Aya Elalfy, Ahmed Elmorsy Mohamed, Zeyad Kholeif, Ramez Barsoom, Mustafa Abomohsen, Ahmed Ali, Rana Rashwan, Imad Samman Tahhan, Mohamed Elnady, Zaid Sarhan, Mohab Elnashar, Danesh Kella, Christoff van Niekerk","doi":"10.1111/pace.70343","DOIUrl":"10.1111/pace.70343","url":null,"abstract":"<p><strong>Background: </strong>In patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF), atrioventricular node ablation (AVNA) and permanent pacing are often pursued when rhythm control is not pursued. Biventricular pacing (BiVP) has demonstrated benefits over right ventricular pacing, while conduction system pacing (CSP) has emerged as an alternative. However, evidence directly comparing CSP with BiVP in this high-risk population remains inconsistent.</p><p><strong>Objective: </strong>To compare CSP versus BiVP in patients with AF and HFrEF undergoing AVNA, focusing on cardiac function, clinical outcomes, and procedural metrics.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science through February 2026 for studies comparing CSP and BiVP in adults with AF and HFrEF undergoing AVNA. Outcomes included all-cause mortality, heart failure hospitalization (HFH), changes in left ventricular ejection fraction (LVEF), QRS duration, New York Heart Association (NYHA) class, pacing threshold, procedure duration, and fluoroscopy duration. A random-effects model was used to pool mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Six studies (one randomized crossover trial and five observational studies; N = 766 patients: CSP = 356, BiVP = 410) were included. All-cause mortality was significantly reduced in favor of CSP (RR 0.64 [CI: 0.44 to 0.94], p = 0.02, I² = 0%). There was also a trend towards lower HFH, but it marginally missed statistical significance (RR 0.77 [CI: 0.58 to 1.03], p = 0.08; I² = 0%). Additionally, CSP decreased NYHA class (MD -0.64 [CI: -1.18 to -0.10], p = 0.02; I² = 85%) and significantly reduced QRS duration (MD -33.56 ms [CI: -52.36 to -14.76], p = 0.0005; I² = 97%). LVEF improvement did not significantly differ between groups (MD 4.51% [95% CI: -1.50 to 10.52], p = 0.14; I² = 98%). Procedure duration and fluoroscopy times did not show statistically significant difference between the two groups (MD -11.54 min [CI: -50.05 to 26.97], p = 0.56, I² = 96%), and (MD -5.75 min [CI: -13.13 to 1.63], p = 0.13, I² = 88%), respectively. Overall pacing thresholds did not significantly differ between CSP and BiVP; however, modality-specific subgroup analysis showed comparable thresholds between HBP and BiVP, whereas LBBP was associated with significantly lower pacing thresholds than BiVP.</p><p><strong>Conclusions: </strong>Among patients with AF and HFrEF undergoing AVNA, CSP may offer symptomatic and electrocardiographic advantages over BiVP, with a possible signal toward improved major clinical outcomes that requires confirmation in larger randomized studies.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1505-1518"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407880","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":"Conduction-System Versus Biventricular Pacing for CRT in HFrEF: Pairwise and Network Meta-Analysis.","authors":"Mustafa Abomohsen, Mohamed Rifai, Azad Mojahedi, Hager Mohamed Bakr, Mohanad A Alkuwaiti, Mohamed S Elgendy, Ahmed A Ibrahim, Mohamed A Sabeha, Abdallah Montaser Salman, Iyad Y Idries, Moshe Gunsburg","doi":"10.1111/pace.70357","DOIUrl":"10.1111/pace.70357","url":null,"abstract":"<p><strong>Background: </strong>Conduction-system pacing (CSP) has emerged as a physiological alternative to conventional biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT) in patients with heart failure with reduced ejection fraction (HFrEF). However, whether CSP provides superior clinical, echocardiographic, procedural, or safety outcomes compared with BiVP remains uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review, pairwise meta-analysis, and frequentist network meta-analysis of randomized controlled trials comparing CSP with BiVP in adults with HFrEF undergoing CRT. PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL were searched from inception to May 5, 2026. The primary outcomes were change in left ventricular ejection fraction (LVEF), heart-failure hospitalization, and all-cause mortality. Secondary outcomes included NYHA functional class, QRS duration, ventricular volumes, procedural metrics, echocardiographic response, feasibility, device-related outcomes, and safety. Risk ratios or mean differences with 95% confidence intervals were pooled using random-effects models. Network meta-analysis compared individual pacing strategies, including His-bundle pacing (HBP), left bundle branch area/left bundle branch pacing, mixed CSP, and BiVP.</p><p><strong>Results: </strong>Nine randomized controlled trials including 976 participants were analyzed. Compared with BiVP, CSP was not associated with a statistically significant improvement in LVEF (MD, 1.90 percentage points; 95% CI, -1.05 to 4.86; p = 0.176), heart-failure hospitalization (RR, 0.83; 95% CI, 0.31 to 2.22; p = 0.660), or all-cause mortality (RR, 1.05; 95% CI, 0.40 to 2.70; p = 0.900). Network meta-analysis showed no statistically significant superiority of any individual CSP modality over BiVP for the primary outcomes. CSP was associated with a modest improvement in NYHA functional class (MD, -0.17; 95% CI, -0.34 to -0.00; p = 0.049), but no significant differences were observed in QRS duration, LVESV, LVEDV, pacing threshold, procedural time, fluoroscopy time, echocardiographic response, procedural success, complications, lead revision, infection or explantation, crossover, or ventricular arrhythmias requiring ICD therapy.</p><p><strong>Conclusions: </strong>In randomized evidence, CSP was not consistently superior to BiVP for LVEF improvement, heart-failure hospitalization, mortality, ventricular remodeling, procedural outcomes, or safety in patients with HFrEF undergoing CRT. CSP may represent a feasible physiological alternative in selected patients and experienced centers, but BiVP remains the established default strategy. Larger randomized trials with standardized CSP capture criteria, longer follow-up, and adequately powered clinical endpoints are needed.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1519-1539"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407894","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 Micra Transcatheter Pacing System Curvature and Capture Threshold During Implantation.","authors":"Qiang Xing, Zukela Tuerhong, Renqing Guo, Jiasuoer Xiaokereti, Jianghua Zhang, Yaodong Li, Xianhui Zhou, Baopeng Tang","doi":"10.1111/pace.70279","DOIUrl":"10.1111/pace.70279","url":null,"abstract":"<p><strong>Background: </strong>No previous studies have examined the relationship between Micra transcatheter pacing system (TPS) curvature and acceptable thresholds during implantation. This study aimed to evaluate the association between Micra TPS curvature and pre-deployment capture thresholds.</p><p><strong>Methods: </strong>The Micra TPS was successfully implanted with the assistance of right ventriculography in 180 patients. The curvature of the Micra TPS prior to deployment was analyzed using archived right anterior oblique (RAO) images from the first deployment, with the aid of Origin software (OriginLab Corporation, USA), while electrical parameters were recorded from 0 to 30 min at 10-min intervals.</p><p><strong>Results: </strong>Among 159 eligible patients, 126 (79.2%) demonstrated acceptable thresholds with a mean curvature of 0.58 ± 0.18. The high-threshold group (n = 33, 20.8%) exhibited significantly greater curvature (1.36 ± 0.64). Receiver operating characteristic analysis indicated that Micra TPS curvature ≤0.799 predicted acceptable thresholds with 90.9% sensitivity and 91.3% specificity (area under the curve = 0.958, 95% confidence interval: 0.924-0.992), with stable thresholds maintained in the acceptable group. No procedural complications occurred.</p><p><strong>Conclusions: </strong>A curvature of ≤0.799 in the RAO view of the Micra TPS prior to deployment reliably indicates acceptable capture thresholds. Combining curvature assessment with right ventriculography enhances the procedural safety of Micra implantation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1588-1594"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960656","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":"Bipolar Radiofrequency Ablation of Atrial Tachycardia Originating From RAA via Pericardium Pathway-A Case Report.","authors":"Liang Xiong, Lili Qiu, Xiaowen Xie, Dandan Wang, Juan Hua, Qinmei Xiong, Jinzhu Hu, Qi Chen","doi":"10.1111/pace.70242","DOIUrl":"10.1111/pace.70242","url":null,"abstract":"<p><p>Atrial tachycardia originating from the right atrial appendage was first reported more than a decade ago, which had been observed to occur more frequently in younger populations. Radiofrequency catheter ablation of this type of tachycardia often yielded suboptimal success rates, largely attributable to the complex anatomical structure of the right atrial appendage. In this report, we presented a successful case of bipolar radiofrequency ablation for atrial tachycardia arising from the right atrial appendage, which might offer a promising approach for the treatment of similar cases in the future.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1559-1562"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597733","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 Bundle Branch Area Pacing Reverts Electromechanical Window Negativity to a Similar Extent as Biventricular Pacing.","authors":"Florien Klein, Metra Daliry, Karin C Smits, Edoardo Bressi, Peter M Deissler, Johan van Koll, Jesse H J Rijks, Antonius M W van Stipdonk, Rachel M A Ter Bekke, Domenico Grieco, Chiara Manfuro, Giorgia Spiridigliozzi, Annalisa Casalese, Justin G L M Luermans, Frits W Prinzen, Roel Meiburg, Leonard M Rademakers, Kevin Vernooy, Uyên Châu Nguyên","doi":"10.1111/pace.70250","DOIUrl":"10.1111/pace.70250","url":null,"abstract":"<p><strong>Background: </strong>Cardiac resynchronization therapy (CRT) through left bundle branch area pacing (LBBAP) has been associated with reduced arrhythmogenic risk compared to biventricular pacing (BiVP). Electromechanical window (EMW) is a marker of electromechanical instability, and a negative EMW is associated with ventricular arrhythmias. We hypothesized that LBBA-CRT increases EMW at least as much as BiVP-CRT does.</p><p><strong>Methods: </strong>129 CRT recipients (LBBAP: n = 63; BiVP: n = 66) were included. EMW and echocardiographic reverse remodeling were evaluated before and 6-12 months after CRT implantation in the entire cohort and in a subgroup of patients with a negative EMW at baseline. EMW is calculated by subtracting the QT interval from the time interval of QRS onset to the aortic valve closure artifact (QAoC) using CW-Doppler echocardiography.</p><p><strong>Results: </strong>EMW measurements were feasible in 67% of patients (n = 86). No significant difference in ΔEMW was observed between LBBAP and BiVP. In patients with a negative EMW at baseline, both CRT strategies led to significant EMW increase (LBBAP: n = 21, ΔEMW +13 ms (IQR -1 to 70), p = 0.003; BiVP: n = 36, ΔEMW +26 ms (IQR -2 to 54), p = 0.006). There was no significant difference between CRT groups (p = 0.779). Left ventricular ejection fraction improved by 10% ± 11% and end-diastolic volume decreased by 37 ± 51 mL (<0.001), with no significant differences between LBBAP and BiVP. In multivariable analysis, a negative EMW at baseline, but not echocardiographic reverse remodeling, was the only independent predictor of EMW increase.</p><p><strong>Conclusion: </strong>In CRT patients with a negative EMW at baseline, LBBAP and BiVP revert EMW to a similar degree.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1464-1472"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680225","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":"QT Interval Evaluation in Right Ventricular Pacing: Validation of a Novel Formula.","authors":"Amr Abdin, Alhasan Almasri, Ibrahim Antoun, Charles Gieres, Christian Werner, Yvonne Bewarder, Christian Ukena, Igor Schwantke, Michael Böhm, Saarraaken Kulenthiran","doi":"10.1111/pace.70239","DOIUrl":"10.1111/pace.70239","url":null,"abstract":"<p><strong>Background: </strong>QT interval measurement in the presence of right ventricular pacing (RVP) represents a clinical challenge. We therefore aimed to derive and validate a formula for QT estimation during RVP in a large cohort of pacemaker patients.</p><p><strong>Methods and results: </strong>We prospectively enrolled 100 patients in a derivation cohort and 487 in a validation cohort. Eligible patients had implanted pacemakers or implantable cardioverter-defibrillators, preserved atrioventricular conduction, and a narrow native QRS. Standardized 12-lead ECGs were recorded during intrinsic rhythm, atrial pacing (AP), and RVP at matched heart rates. Linear regression of QT during non-paced rhythm against paced QT yielded the equation: QT_non-paced = 139.23 + 0.55 × QT_paced. In the validation cohort (mean age 71 ± 13 years, 72% male), application of the formula showed a significant correlation between predicted and observed QT values (r = 0.50, p < 0.001). Bland-Altman analysis demonstrated a modest mean overestimation of 15 ms, with consistent accuracy across subgroups defined by sex, device type, and lead position. Compared directly with the Bogossian method, our formula showed superior performance, with a lower mean absolute deviation (26.2 vs. 39.9).</p><p><strong>Conclusion: </strong>This novel, heart rate-independent formula provides a reliable method for estimating the intrinsic QT interval from paced measurements. It represents a practical tool to improve QT assessment and arrhythmic risk evaluation in patients with RVP, with potential implications for clinical decision-making and drug safety monitoring.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1455-1463"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611575","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":"Safety and Performance of INVICTA DF4 Ventricular Defibrillation Lead: Results From APOLLO Prospective Multicenter Study.","authors":"Klaus K Witte, Juan Gabriel Martínez, Mário M Oliveira, Alberto Barrera, Maite Izquierdo, Cosimo Mandurino, Maria Emilce Trucco, José Juan García Salvador, Antoine Dompnier, Frédéric Jean, Pablo J Sánchez Millán, Carsten Israel, Maria Martino, Pedro Marques","doi":"10.1111/pace.70286","DOIUrl":"10.1111/pace.70286","url":null,"abstract":"<p><strong>Background: </strong>Implantable cardioverter-defibrillator (ICD) therapy relies on reliable right ventricular leads for pacing, sensing, and defibrillation. The INVICTA DF4 lead is an active-fixation, quadripolar design intended to optimize implant workflow and long-term safety and performance.</p><p><strong>Methods: </strong>APOLLO was a prospective, multicenter, single-arm, observational study enrolling adults across Europe with guideline-based indications for de novo ICD or Cardiac Resynchronization Therapy Defibrillator (CRT-D) implantation who received an INVICTA DF4 lead (single- or dual-coil; 58 or 68 cm). The co-primary endpoints focused on safety and performance at 3 months, while secondary endpoints included long-term electrical variables, arrhythmia termination, and lead-related complications through 24 months.</p><p><strong>Results: </strong>Between June 4, 2021, and October 19, 2022, 446 patients were implanted across 45 sites in 8 European countries. The INVICTA lead was successfully implanted in 100% of the 446 enrolled patients. Leads were positioned either in the apex in 57.2% or right ventricle (RV) septum in 42.8%. Electrical variables stabilized after discharge and remained stable up to 24 months (M24 mean pacing threshold 0.85 ± 0.33 V at 0.5 ms; sensing 13.39 ± 3.17 mV; pacing impedance 525.5 ± 94.2 Ohms; right ventricular (RV) coil continuity 427.8 ± 82.7 Ohms). Of 86 arrhythmic episodes requiring defibrillation, 97.7% were successfully terminated. Lead-related complication free rate was 97.5% at 30 days, 98.9% at 31-730 days, and 96.4% overall. Mortality was 8.5% (38/446) at two years, of which 63% was due to cardiovascular causes.</p><p><strong>Conclusions: </strong>In a large, contemporary European cohort, the INVICTA DF4 ventricular lead demonstrated high implant success, durable electrical performance, effective arrhythmia termination, and low complication rates through 24 months. A trend toward less complication in septal positioning was observed compared to apical placement, with comparable electrical performance.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1595-1603"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959381","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":"Impact of Leadless Pacemaker Implantation Position on Subclinical Right Ventricular Perforation.","authors":"Young Shin Lee, Jae-Sun Uhm, Je-Wook Park, Seung-Jung Park, Ye Chan Kim, In-Soo Kim, Hye-Jeong Lee, Moon-Hyun Kim, Hanjin Park, Daehoon Kim, Hee Tae Yu, Tae-Hoon Kim, Jin-Bae Kim, Jong-Youn Kim, Boyoung Joung, Hui-Nam Pak, Moon-Hyoung Lee","doi":"10.1111/pace.70218","DOIUrl":"10.1111/pace.70218","url":null,"abstract":"<p><strong>Introduction: </strong>Leadless pacemakers are typically implanted in the mid-septum of the right ventricle (RV) to mitigate the risk of perforation. However, reports on the precise location of these implants are limited. This study aimed to elucidate tine-based leadless pacemaker position and presence of subclinical RV perforation through computed tomography (CT) imaging, along with the associated prognosis.</p><p><strong>Methods: </strong>Patients who underwent heart, chest or abdomen CT after leadless pacemaker implantation were consecutively included. Two cardiologists and one radiologist reviewed the CT images to assess the position of tines and to detect RV perforation. The implantation position was categorized as the septum, RV free wall, junction of septum and RV free wall, moderator band, and RV apex. Subclinical perforation was defined as the tines of a leadless pacemaker beyond the outer myocardial contour without symptoms, pericardial effusion, hemodynamic instability, or pacemaker malfunction.</p><p><strong>Results: </strong>A total of 88 patients (age, 72.9 ± 12.1 years; 42 males) were included. The interval between procedure and CT scanning was 8.6 ± 9.2 months. In 68 patients (77.3%), the leadless pacemaker was implanted at the junction of the septum and the RV free wall. Subclinical RV perforation occurred in 15 patients (17.0%). Among patients with RV perforation, the most common implantation site was the junction of the septum and the RV free wall. None of the patients with RV perforation experienced any adverse events for 12.4 ± 12.3 months.</p><p><strong>Conclusions: </strong>The most common leadless pacemaker implantation site is the junction of the septum and the RV free wall. Subclinical RV perforation is not uncommon and not associated with overt adverse outcomes.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1447-1454"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577667","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}