Pacing and clinical electrophysiology : PACE最新文献

{"title":"Characteristics of Cardiomyopathy in Patients With Chronic Left Bundle Branch Block Undergoing Right Ventricular Pacing.","authors":"Temidayo A Abe, Favour Markson, Daniel J Friedman, Larry R Jackson","doi":"10.1111/pace.70020","DOIUrl":"10.1111/pace.70020","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch block (LBBB) and right ventricular pacing (RVP) are associated with abnormal myocardial mechanics and cardiomyopathy. Consequently, chronic LBBB may increase the risk of heart failure and mortality in patients undergoing RVP.</p><p><strong>Methods: </strong>Using the TriNetX Analytics Network database, we identified patients who underwent pacemaker implantation between January 1, 2014 and January 1, 2024. Exclusion criteria included a history of heart failure, previous cardiac devices, cardiac resynchronization therapy (CRT) during the index hospitalization, or a left ventricular ejection fraction (LVEF) of less than 50%. The primary outcome incident systolic heart failure and all-cause mortality occurring from the index hospitalization through November 2024.</p><p><strong>Results: </strong>Among 70,526 patients undergoing RVP implantation, 3916 (5.6%) had chronic LBBB prior to the procedure, with a median age of 75 ± 15 years. Over a median follow-up of 2.5 years, 5356 (7.6%) developed incident systolic heart failure, and 9714 (13.7%) experienced all-cause mortality. After propensity score matching, chronic LBBB was associated with a higher risk of systolic heart failure (HR: 1.39; 95% CI: 1.20-1.62) but not all-cause mortality (HR: 0.93; 95% CI: 0.83-1.06). Patients with chronic LBBB who developed systolic heart failure were more likely to present with moderately depressed LVEF and require CRT upgrades during follow-up compared to those without chronic LBBB.</p><p><strong>Conclusion: </strong>Chronic LBBB was associated with a higher risk of systolic heart failure, worse left ventricular function, and greater likelihood of CRT upgrade among patients undergoing RVP.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"973-980"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802408","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 Obesity in Hospitalized Patients Undergoing Catheter Ablation for Atrial Fibrillation.","authors":"Shafaqat Ali, Sanchit Duhan, Manoj Kumar, Bilal Hussain, Lalitsiri Atti, Pramod Kumar Ponna, Faryal Farooq, Bijeta Keisham, Yasar Sattar, Vijaywant Brar, Zain Ul Abideen Asad, Tarek Helmy, Hakan Paydak, Paari Dominic","doi":"10.1111/pace.70026","DOIUrl":"10.1111/pace.70026","url":null,"abstract":"<p><strong>Introduction: </strong>Morbid obesity is a well-known risk factor for the development of Atrial Fibrillation (AF); however, its influence in patients undergoing Catheter Ablation (CA) for AF is poorly recognized.</p><p><strong>Methods: </strong>The NRD (2016-2020) was used to identify CA for AF. Cohorts were stratified as non-obese (BMI <25), obese (BMI 30-39), and morbidly obese (BMI ≥ 40). Multivariate regression and propensity-matched models were used.</p><p><strong>Results: </strong>Among 83,767 CAs for AF, 10,590 (12.6%) were morbidly obese population. On propensity-matched cohorts (N: 5741), morbid obesity was associated with higher rates of acute HF (39.1% vs. 34.5%), sudden cardiac arrest (5.6% vs. 4.7%), post-procedural bleeding (1.95% vs. 1.36%), AKI (21.7% vs. 16.3%), and respiratory complications (18.9% vs. 13.2%). Morbid obesity was also associated with higher median LOS (4 vs. 3 days) and higher total cost ($43,768 vs. $39,026). From 2016-2020, the total cost increased irrespective of the obesity status (p_trend < 0.05); however, LOS showed a decreasing trend for non-obese (p_trend < 0.05) but remained the same for morbidly obese patients (p_trend > 0.05). The 30-day (11.7% vs. 8.4%) and 180-day (29.9% vs. 24.9%) all-cause readmission rates were significantly higher for the morbidly obese compared to non-obese patients. Post-discharge, AF was the most common cause (69.2% & 66.8%) for 30 and 180-day readmissions. Our subgroup analysis comparing obese (BMI 30-39) to non-obese showed higher rates of periprocedural acute HF and respiratory complications (p < 0.05).</p><p><strong>Conclusion: </strong>Morbid obesity in patients undergoing CA for AF was associated with higher rates of periprocedural adverse events, healthcare-related burden, and readmission rates.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1047-1058"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802410","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 After Transcatheter Aortic Valve Implantation. A Single Center Experience.","authors":"Paula Vela-Martín, Juan Francisco Oteo, Eusebio Garcia-Izquierdo, Carlos Arellano-Serrano, Alvaro Lorente-Ros, Melodie Segura-Dominguez, Arturo Garcia-Touchard, María Del Trigo, Jose Antonio Fernandez-Diaz, Victor Castro-Urda","doi":"10.1111/pace.70028","DOIUrl":"10.1111/pace.70028","url":null,"abstract":"<p><strong>Background: </strong>Permanent pacing after transcatheter aortic valve implantation (TAVI) causes higher rates of death, heart failure (HF) hospitalization and decline in left ventricular ejection fraction (LVEF). Left bundle branch area pacing (LBBAP) may mitigate these adverse events, although experience is limited yet.</p><p><strong>Objective: </strong>To describe the feasibility, safety and clinical outcomes of LBBAP after TAVI during the first year of follow-up.</p><p><strong>Methods: </strong>Single-center, retrospective observational study of patients who underwent LBBAP after TAVI between January 2020 and December 2023. Indication for permanent pacing, procedural details, LVEF and NTproBNP were assessed at implantation. Changes in electrophysiological parameters, LVEF, NtproBNP and adverse clinical events were evaluated at 1 year follow-up.</p><p><strong>Results: </strong>A total of 49 patients underwent LBBAP after TAVI, primarily due to pathologycal eletrophysiological study (44.9%) or complete/high degree atrioventricular block (42.9%). LBBAP reduced QRS duration post-TAVI (147.1 ± 26.4 ms vs. 119.6 ± 12.6 ms, p < 0.001). Acute complications occurred in 10.2% of patients, resolving during hospitalization. During follow-up (15.6 ± 7.0 months), improvement in capture threshold and reduction in ventricular lead impedance were observed. NTproBNP levels decreased significantly, while LVEF remained stable (61.8% [52.0-67.2] vs. 59.0% [51.0-66.0], p = 0.357). Notably, the six patients with baseline LVEF < 40% showed significant LVEF improvement. A total of 12.2% of patients were hospitalized for HF and 12.2% died (half of them due to cardiovascular causes). Multivariate analysis identified atrial fibrillation as the sole predictor of adverse outcomes.</p><p><strong>Conclusions: </strong>LBBAP post-TAVI is a feasible and safe pacing strategy, demonstrating favorable electrophysiological and clinical outcomes over 1-year follow-up.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1059-1068"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819080","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 Science Behind Pulsed Field Ablation: What Every Clinician Should Know.","authors":"Wilber Su","doi":"10.1111/pace.70023","DOIUrl":"https://doi.org/10.1111/pace.70023","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802412","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":"Machine Learning-Based Prognostic Models for Mortality in Patients Receiving Implantable Cardioverter Defibrillators.","authors":"Lei Pan, Xi Liu, Li Zhu, Ziqing Yu, Jingfeng Wang, Xiao Li, Weiwei Zhang, Ruogu Li, Zhongkai Wang, Hongyang Lu, Shengwen Yang, Peizhao Li, Yangang Su, Wei Hua, Yixiu Liang","doi":"10.1111/pace.70008","DOIUrl":"10.1111/pace.70008","url":null,"abstract":"<p><strong>Background: </strong>Accurately predicting the clinical trajectory of patients with implantable cardioverter-defibrillators (ICDs) is critical for guiding their care and management. Machine learning (ML) methods surpass traditional statistical approaches by addressing complex data patterns and variability, providing more precise and personalized risk estimates.</p><p><strong>Methods: </strong>This retrospective study included patients from four major hospitals in China. Data from three hospitals were used for training and internal tests, while data from the remaining hospital were used for external tests. Six ML models were developed and validated. Model discrimination was measured using the area under the receiver operating characteristic curve (AUROC). Kaplan-Meier survival curves were generated by stratifying patients into high-risk and low-risk groups based on the optimal model's predictions. Interpretation analysis was performed to rank the importance of predictive features.</p><p><strong>Results: </strong>A total of 3175 patients were studied. The multilayer perceptron (MLP) model demonstrated superior predictive accuracy, with the AUROC of 0.70 and 0.72 in internal and external test sets, respectively, outperforming other models. Kaplan-Meier curves show distinct survival trends over time between high-risk and low-risk groups, with stratification determined by the MLP model using a Youden's index cut-off value of 0.3443 (p < 0.001). Among the seven key predictors identified, glomerular filtration rate (GFR) was the most influential factor.</p><p><strong>Conclusions: </strong>The MLP model effectively predicted 3-year survival for ICD or cardiac resynchronization therapy defibrillator (CRT-D) patients and accurately stratified them into distinct risk groups. The integration of MLP and SHapley Additive exPlanations (SHAP) provided explicit explanations for individualized risk predictions, facilitated clinical decision-making, and supported the optimization of treatment strategies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05396313.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"906-916"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586214","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":"Depression and Anxiety in Patients Who Received a CRT Device and Did Not Have Shock Therapy During a 12-Month Follow-Up.","authors":"Elizabeth Florou, Dimitrios Sfairopoulos, Sofia Plakoutsi, Aris Bechlioulis, Konstantinos Zekios, Haralampos Milionis, Petros Skapinakis, Panagiotis Korantzopoulos","doi":"10.1111/pace.70002","DOIUrl":"10.1111/pace.70002","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac resynchronization therapy (CRT) may affect the patients' psychological status differently in various populations. There are limited data regarding depression and anxiety in this setting, while there are no data regarding Greek patients.</p><p><strong>Methods: </strong>We studied heart failure with reduced ejection fraction (HFrEF) patients, without conditions affecting psychological status, undergoing CRT. We used the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 9-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Scale (GAD-7) at baseline and 6- and 12-month postimplantation.</p><p><strong>Results: </strong>After excluding seven patients who experienced defibrillator shocks, we analyzed 99 patients (median age: 72 years, 77% men). The baseline MLHFQ score was 37 (interquartile range [IQR]: 36); at 6 months, 1 (IQR: 8); and at 12 months, 0.5 (IQR: 10); p < 0.01. The baseline PHQ-9 score was 9 (IQR: 11); at 6 months, 0 (IQR: 2); and at 12 months, 0 (IQR: 2); p < 0.01. The baseline GAD-7 score was 8 (IQR: 16); at 6 months, 0 (IQR: 1.5); and at 12 months, 0 (IQR: 3); p <0.01. At baseline, 44% of patients had clinically significant depression (PHQ-9 score ≥10), and 45% clinically significant anxiety (GAD-7 score ≥10). The baseline PHQ-9 and GAD-7 scores correlated with the MLHFQ score. The logistic regression analysis revealed that clinically substantial depression at baseline (PHQ-9 ≥ 10) had a negative association with chronic kidney disease [OR: 0.55; p < 0.01].</p><p><strong>Conclusions: </strong>Depression and anxiety markedly improved during the 12-month follow-up period after CRT device implantation in HFrEF patients who did not receive shock therapy.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"925-931"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487748","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":"Thermal Profile of Contact Force Dependent Pulse Field Electroporation Beyond Calcium Electroporation at the Koch Triangle.","authors":"Yiqi Lu, Huimin Chu, Rong Bai, Feifan Ouyang, Zhenyu Jia, Mingjun Feng, Xianfeng Du, Si Chen, Lipu Yu, Jiating Dai, Tingsha Du, Weidong Zhuo, Yijun Sun, Xinzhi Yu, Chenxu Luo, Caijie Shen","doi":"10.1111/pace.70013","DOIUrl":"10.1111/pace.70013","url":null,"abstract":"<p><strong>Background: </strong>Contact force (CF)-dependent pulse field electroporation (PFE) may generate tissue heating, affecting junctional rhythm at the triangle of Koch (ToK) in a clinical setting. PFE may also disrupt calcium homeostasis, causing calcium electroporation (CE) for some Joule heating. The impact of CF on PFE and CE for electrode temperature (ET) at the ToK has not been validated.</p><p><strong>Methods: </strong>A CF-sensing catheter with an ET probe was positioned perpendicularly on dissected ToK from 12 swine. PFE was applied in four groups: low CF-calcium chloride (CC, 5.0 mM; LCF-CC, 2-10 g), high CF-CC (HCF-CC, 11-50 g), LCF-saline solution (SS; CF-SS, 2-10 g), and HCF-SS (11-50 g). ET changes derived from (LCF-CC minus LCF-SS) and (HCF-SS minus LCF-SS) was operationally defined as dominant CE (DCE) and PEF (DPFE) components, respectively.</p><p><strong>Results: </strong>Fewer time-temperature curves with straight, abrupt surge (AS) followed by sudden descent (SD) were observed in LCF-CC versus other groups (p < 0.001). The delayed AS-maximal temperature (MT) curve is almost absent in the LCF-SS versus LCF-CC group (6.3% vs. 70.3%, p < 0.001). The highest △AS-MT was detected in HCF-CC and LCF-CC groups (4.3 ± 0.7°C vs. 4.3 ± 1.0°C, p = 0.37). △△AS-MT was larger from DCE than the DPFE effect (1.1 ± 1.0°C vs. 0.4 ± 0.4°C, p < 0.001). Although △SD-MT was similar in DCE and DPFE groups (p > 0.05), △△SD-MT (resistance to △SD-MT) was more prominent in DCE (0.2 ± 0.5 vs. -0.1 ± 0.5, p < 0.05). More extensive △SD-MT/duration was synchronously changed with short duration in LCF-CC or HCF-SS versus HCF-CC, and DCE group (p < 0.05).</p><p><strong>Conclusions: </strong>The in vitro model showed biphasic ET changes (initial rise followed by decline) correlated with CF-dependent CE and PFE. CF significantly modulated ET dynamics while maintaining safe thermal thresholds. Further studies should clarify how this biphasic pattern affects junctional rhythm generation in vivo conditions.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"843-851"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661752","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 Stylet-Driven Leads for Left Bundle Branch Area Pacing in Octogenarians.","authors":"Ahmet Korkmaz, Elif Hande Ozcan Cetin, Koray Arslan, Mehmet Serkan Cetin, Mücahit Göl, Hasan Can Könte, Meryem Kara, Fırat Ozcan, Ozcan Ozeke, Serkan Cay, Dursun Aras, Serkan Topaloglu","doi":"10.1111/pace.70010","DOIUrl":"10.1111/pace.70010","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) is emerging as a physiological alternative to conventional pacing, particularly in elderly patients. Stylet-driven leads (SDL) offer unique procedural advantages, but data on their safety and efficacy in octogenarians remain sparse.</p><p><strong>Objective: </strong>This study evaluates the feasibility, safety, and outcomes of SDL for LBBAP in octogenarians.</p><p><strong>Methods: </strong>A retrospective, single-center study included 117 octogenarian patients (≥80 years) and 308 younger patients (<80 years) who underwent LBBAP with SDL between May 2022 and December 2023. Baseline characteristics, procedural success, and follow-up outcomes were analyzed. Complication rates and pacing parameters were assessed over 12 months.</p><p><strong>Results: </strong>Procedural success was high in both groups (93.2% in octogenarians vs. 96.1% in younger patients). Octogenarians had slightly longer fluoroscopy times (13.2 ± 1.4 vs. 11.8 ± 1.6 min, p = 0.031) and higher pacing thresholds at implantation (1.03 ± 0.56 V vs. 0.82 ± 0.42 V, p = 0.001). At 12 months, event-free survival was 91.4% in octogenarians and 94.8% in younger patients (p = 0.288). The overall complication rate was low (5.1% vs. 3.6%, p = 0.957), and no significant differences in pacing parameters were observed between groups. Improvements in left ventricular ejection fraction (LVEF) and QRS duration were consistent across both cohorts.</p><p><strong>Conclusion: </strong>SDLs are safe and effective for LBBAP in octogenarians, providing high procedural success and significant clinical improvements. These findings highlight the potential of SDL as a viable option for elderly patients requiring physiological pacing, addressing the unique challenges posed by advanced age.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"821-826"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586216","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":"Predictive Parameters for Impending Steam Pops During High-Power Short-Duration Ablation for Atrial Fibrillation.","authors":"Yan Luo, Shiqiang Xiong, Ashkan Ehdaie, Huaxin Sun, Guoshu Yang, Duan Luo, Jun Li, Xunzhang Wang, Zhen Zhang, Lin Cai, Hanxiong Liu, Michael Shehata","doi":"10.1111/pace.70003","DOIUrl":"10.1111/pace.70003","url":null,"abstract":"<p><strong>Background: </strong>High-power short-duration (HPSD) radiofrequency ablation (RFA) for atrial fibrillation (AF) treatment carries the risk of steam pops (SPs) due to rapid tissue heating. However, methods to predict impending SP during HPSD-RFA remain undefined.</p><p><strong>Objective: </strong>This study aims to establish a quantitative criterion for predicting SPs during HPSD-RFA.</p><p><strong>Methods: </strong>Retrospective analysis was performed on 489 patients undergoing HPSD-RFA for AF, focusing on corresponding RFA parameters in those who experienced SPs.</p><p><strong>Results: </strong>Among 1943 ablation lesions (ALs) delivered in 18 patients with SPs, 24 ALs had SP occurrence. Tip temperature, RFA duration, and ablation index were not significantly different between SP ALs and non-SP ALs. The mean contact force was significantly higher in SP ALs (12 g vs. 9, p < 0.001). All SPs adhered to the following criteria: impedance drop ≥8Ω during the first 4 s of RFA, impedance variability <5Ω within the first 4 s of RFA (24/24 vs. 79/247, p < 0.001), no events in the posterior wall of the left atrium, impedance drop ≥12Ω within 4-12 s. By halting delivery of RFA early with this finding in approximately five ALs per patient, the risk of SP complications could be significantly mitigated.</p><p><strong>Conclusion: </strong>Monitoring impedance trends in the initial 4 s of HPSD-RFA can effectively predict impending SP occurrences. Automated algorithms should be developed to halt RFA delivery in this setting.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"836-842"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586215","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":"Use of Direct Oral Anticoagulants Following Cardiac Implantable Electronic Device Placement.","authors":"Carmel Ashur, Li Qin, Karl E Minges, James V Freeman, Sana M Al-Khatib, Steven M Bradley, P Michael Ho, Wendy S Tzou, Paul D Varosy, Paul L Hess, Amneet Sandhu","doi":"10.1111/pace.70016","DOIUrl":"10.1111/pace.70016","url":null,"abstract":"<p><strong>Background: </strong>Small studies have described the safety of uninterrupted direct oral anticoagulant (DOAC) use in atrial fibrillation (AF) patients undergoing elective, cardiac implantable electronic device (CIED) placement. Real-world practice patterns and associated outcomes remain poorly defined.</p><p><strong>Objective: </strong>Describe DOAC usage trends following uncomplicated, outpatient CIED placement in AF patients and evaluate clinical outcomes based on DOAC status at discharge.</p><p><strong>Methods: </strong>Using data from the National Cardiovascular Data Registry, AF patients with CHA₂DS₂-VASc ≥ 2 undergoing uncomplicated, outpatient CIED placement from April 2016 to December 2019 were stratified by DOAC prescription at discharge. Short and longer-term temporal trends and post-discharge outcomes were assessed using Centers for Medicare and Medicaid (CMS) claims.</p><p><strong>Results: </strong>Among 59,169 AF patients with elevated thromboembolic eligible for DOAC therapy who underwent elective, new CIED implant or generator replacement, 32,025 (54.1%) were discharged on a DOAC. Annual rates of DOAC use at discharge increased from 47.0% in 2016 to 62.5% in 2019 (p < 0.0001). Overall, patients discharged on DOAC had higher adjusted rates of pocket hematoma (0.51% vs. 0.33%, p = 0.0007) and lower rates of stroke (2.9% vs. 3.2%, p = 0.05) at 30-days but no significant differences in device infection or need for revision at 30-days or 1-year. Those undergoing new CIED implant had higher rates of pocket hematoma at 30-days (0.53% vs. 0.36%, p = 0.02) and need for device revision at 1-year (1.6% vs. 1.3%, p = 0.04).</p><p><strong>Conclusion: </strong>In AF patients undergoing CIED implantation, about half were discharged on DOACs, with increasing rates of DOAC resumption immediately following post-CIED implantation over the study period. Those discharged on DOACs had modestly higher rates of pocket hematoma or need for device revision but similar risk of device infection.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"859-869"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763055","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}