Pacing and clinical electrophysiology : PACE最新文献

{"title":"Affordable and Efficient Anatomy Mapping for LBBAP in Dextrocardia With Complete Heart Block.","authors":"Chanadda Rutnuntamongkon, Ronpichai Chokesuwattanaskul","doi":"10.1111/pace.70443","DOIUrl":"https://doi.org/10.1111/pace.70443","url":null,"abstract":"<p><p>We reported the case of a 77-year-old woman with dextrocardia and complete heart block, demonstrating the effectiveness of simplified anatomical mapping imaging and modified catheter techniques to achieve selective left bundle branch pacing (LBBP).</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083776","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":"Lead-to-Vein Ratio and Long-Term Vascular Safety After Transvenous Pacing in Children Weighing ≤15 Kg.","authors":"Michel Cabrera Ortega, Juan Carlos Ramiro Novoa, Osmin Castañeda Chirino, Adel Eladio González Morejón, Giselle Serrano Ricardo, Yoel Coto Hernández, Mabel Elena Dominguez Gonzalez, Liz Coto Pérez, Agustín Fernández-Cisnal","doi":"10.1111/pace.70454","DOIUrl":"https://doi.org/10.1111/pace.70454","url":null,"abstract":"<p><strong>Background: </strong>Transvenous pacing in low-weight children is technically feasible, but its clinical use depends on long-term venous patency, system performance, and ventricular function. We aimed to describe imaging-defined venous abnormalities and clinically overt vascular events after first transvenous pacemaker implantation and to explore whether the lead-to-vein ratio provides anatomical information beyond body weight.</p><p><strong>Methods: </strong>This prospective observational cohort included 35 children weighing ≤15 kg undergoing first transvenous pacemaker implantation between 2010 and 2020. The primary vascular endpoint was imaging-defined venous thrombosis, occlusion, or stenosis ≥50%; clinical impact was recorded separately. Device-related safety, minimum venous diameter, lead-to-vein ratio, ventricular function, synchrony, and paced QRS duration were analyzed using non-parametric, exact, and exploratory univariable tests.</p><p><strong>Results: </strong>Median follow-up was 6.7 [4.5-8.2] years. Eleven patients weighed <10 kg and 3 weighed <5 kg. The imaging-defined vascular endpoint occurred in 6/35 patients; 5 were asymptomatic surveillance findings and 1 was clinically symptomatic. The lead-to-vein ratio was higher in patients with the endpoint than in those without events (0.59 [0.55-0.63] vs. 0.47 [0.43-0.51]; p = 0.003). A ratio >0.55 was associated with more frequent imaging-defined endpoints (4/8 vs. 2/27; odds ratio 12.5; 95% confidence interval 1.7-92.3). Left ventricular ejection fraction remained preserved.</p><p><strong>Conclusion: </strong>During the first transvenous system lifespan, imaging-defined venous abnormalities were relatively frequent but mostly asymptomatic, whereas clinically overt vascular complications were uncommon. The lead-to-vein ratio may support anatomical pre-implant risk stratification, although multicenter validation and follow-up beyond generator replacement are required.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077512","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 Prediction Score for Cardiovascular Implantable Electronic Device Infection in Non-Staphylococcus aureus Bacteremia.","authors":"Supavit Chesdachai, Larry M Baddour, Guillermo Cuervo, Abhishek J Deshmukh, Christopher V DeSimone, Brian D Lahr, Daniel C DeSimone","doi":"10.1111/pace.70456","DOIUrl":"https://doi.org/10.1111/pace.70456","url":null,"abstract":"<p><strong>Background: </strong>Patients with cardiovascular implantable electronic devices (CIEDs) who develop bacteremia require risk stratification for device infection. Although prediction scores exist for Staphylococcus aureus bacteremia, no comparable CIED-specific tool exists for non-S. aureus bacteremia. Our study aimed to estimate the probability of definite CIED infection in adults with non-S. aureus bacteremia without pocket infection.</p><p><strong>Methods: </strong>We performed a prediction-model analysis of adults with CIEDs and non-S. aureus bacteremia, comprising gram-negative bacteremia (GNB) and gram-positive cocci other than S. aureus (GPC) bacteremia, at Mayo Clinic Rochester during 2012-2019. Patients with pocket infection were excluded. Definite CIED infection was classified using 2019 European Heart Rhythm Association criteria. Penalized logistic regression was used to construct two prediction models for definite infection: a full model with nine prespecified predictors, and a reduced model from which a point-based risk score could be obtained.</p><p><strong>Results: </strong>A total of 282 patients with CIEDs developed non-S. aureus bacteremia. Median age was 75 years; 69% were men. GPC bacteremia occurred in 156 patients (55%) and GNB in 126 (45%). Sixty patients (21%) had definite CIED infection. Both the full and reduced models demonstrated excellent predictive discrimination (apparent area under receiver operating characteristic curve 0.946 and 0.940). The reduced model retained four predictors: GPC bacteremia, persistent bacteremia, longer time to positivity, and unknown bacteremia source.</p><p><strong>Conclusion: </strong>A four-variable risk score incorporating organism category, persistent bacteremia, time to positivity, and unknown bacteremia source may guide early device-focused evaluation, but external validation is required before clinical adoption.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083744","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 AV Node Ablation Plus CRT Compared to AF Catheter Ablation in Patients With AF and HFrEF.","authors":"Abhiram Challa, Sittinun Thangjui, Amro Taha, Harsh Patel, Tejasri Polana, Het Patel, Saim Rana, Angkawipa Trongtorsak, Natee Deepan, David Schwartzman, Sandeep Arora","doi":"10.1111/pace.70423","DOIUrl":"https://doi.org/10.1111/pace.70423","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is an established rhythm-control strategy for atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF), while atrioventricular node ablation with cardiac resynchronization therapy (AVNA+CRT) is often used in older patients with advanced disease when durable rhythm control is less feasible. Comparative long-term outcomes remain unclear.</p><p><strong>Methods: </strong>Using the TriNetX Research Network, we identified adults with HFrEF and AF from 2016 who underwent AF ablation or AVNA+CRT from 2016-2023 and 2016-2020 for the 2- and 5-year analysis, respectively. Propensity score matching was performed separately using 58 prespecified covariates. Outcomes included embolic events (stroke/systemic embolism), all-cause mortality, heart failure (HF) hospitalization, and heart transplant/left ventricular assist device (LVAD) implantation.</p><p><strong>Results: </strong>The 2-year cohort included 16,276 patients (2899 AVNA+CRT; 13,377 AF ablation); the 5-year cohort included 7370 patients (1463 AVNA+CRT; 5907 AF Ablation). After matching, AVNA+CRT was associated with higher all-cause mortality (RR 1.580, 95% CI 1.389-1.799), HF hospitalization (RR 1.106, 95% CI 1.040-1.176), and heart transplant/LVAD implantation (RR 2.381, 95% CI 1.142-4.975), with no difference in embolic events at 2 years. At 5 years, AVNA+CRT remained associated with higher mortality (RR 1.350, 95% CI 1.198-1.522; p < 0.001), while HF hospitalization, embolic events, and heart transplant/LVAD implantation did not differ significantly.</p><p><strong>Conclusion: </strong>In a large propensity matched HFrEF-AF cohort, AVNA+CRT was associated with higher mortality at 2 and 5 years than AF ablation, with excess HF hospitalization and transplant/LVAD at 2 years, whereas HF hospitalization rates were similar at 5 years. Prospective studies are needed to refine patient selection in older, medically complex patients.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083726","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":"Multiple Accessory Pathways in Children: Electrophysiological Features and Catheter Ablation Outcomes.","authors":"Emine Gülşah Torun, Nevin Özdemiroğlu, Asiye Yıldız, Zeynep Ömeroğulları, Muhammed Ali Ekşi, Serhat Koca","doi":"10.1111/pace.70455","DOIUrl":"https://doi.org/10.1111/pace.70455","url":null,"abstract":"<p><strong>Background: </strong>Multiple accessory pathways (MAPs) may complicate electrophysiological assessment and catheter ablation in pediatric patients. We aimed to evaluate the clinical and electrophysiological characteristics, anatomical distribution, and procedural and follow-up outcomes of pediatric patients with MAPs.</p><p><strong>Materials and methods: </strong>This retrospective study included pediatric patients with at least two distinct accessory pathways identified during EPS between November 2019 and February 2026.</p><p><strong>Results: </strong>Of 1101 patients who underwent catheter ablation, 619 had accessory pathway-related arrhythmias; among these, 31 (5.0%) had MAPs. The mean age and body weight at the first procedure were 12.1 ± 3.6 years and 44.2 ± 18.8 kg, respectively, and 16 patients were female. Nine patients had structural heart disease, including seven with Ebstein anomaly. A total of 66 accessory pathways were identified: 28 patients had two pathways, two had three, and one had four. The right posteroseptal region was the most common pathway location (27.3%). One patient also had atrioventricular nodal reentrant tachycardia. Complete elimination of all accessory pathways was achieved in 29 of 31 patients (93.5%), and 63 of 66 pathways (95.5%) were successfully ablated. Recurrence occurred in six patients (19.4%). No procedure-related complications were observed during a mean follow-up of 26.3 ± 18.7 months.</p><p><strong>Conclusion: </strong>MAPs were successfully treated with high acute success rates and no procedure-related complications. Nevertheless, recurrence and the identification of additional accessory pathways during subsequent evaluations remained clinically relevant, supporting the need for systematic post-ablation reassessment and long-term follow-up.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077514","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":"Ability of the HALP Score to Predict Cardiac Implantable Electronic Device-Related Complications.","authors":"Gamze Yeter Arslan, Serdar Söner","doi":"10.1111/pace.70441","DOIUrl":"https://doi.org/10.1111/pace.70441","url":null,"abstract":"<p><strong>Background: </strong>The hemoglobin, albumin, lymphocyte, and platelet score (HALP) is a recently defined score that indicates patients' inflammation and nutritional status. This score is associated with poor outcomes in cardiovascular diseases. We aimed to examine the relationship between the HALP score and complications related to cardiac implantable electronic devices (CIED) in patients undergoing CIED procedures.</p><p><strong>Methods: </strong>Our study included 998 patients who underwent CIED implantation in our hospital between January 2019 and May 2022. Patients were divided into two groups according to the median HALP score. The low HALP score group consisted of patients with a HALP score < 40.63, and the high HALP score group consisted of patients with a HALP score ≥40.63. There were 499 patients in both groups. The endpoint of our study was cumulative events, including infection, pneumothorax, and hematoma secondary to CIED.</p><p><strong>Results: </strong>The mean age of the population was 63.9 ± 13.8 years, and 61.5% (615) of the population were male patients. In the multivariate logistic regression analyses, hypertension (OR = 4.216, p < 0.001), biventricular ICD implantation (OR = 16.894, p < 0.001), and HALP score (OR = 0.973, p < 0.001) were independent predictors of cumulative event. In the ROC curve analysis, the HALP score cut-off value of 40.03 was 60.8% sensitive and 52.4% specific for cumulative events (AUC = 59.5%, p = 0.007).</p><p><strong>Conclusion: </strong>Our study observed that the HALP score was an independent predictor of cumulative complications related to CIED procedures. In light of this study, we think that the easily calculated HALP score may be useful in predicting complications in physicians performing CIED procedures.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043366","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":"Vascular Closure Devices After Femoral Access in Adult EP Procedures: Updated Systematic Review and Meta-Analysis.","authors":"Hasnain Wajeeh Saqib, Mohamed Nasser Elshabrawi, Arpitha Sirichandana Baggu, Vikramjit Purewal, Shaiza Maryam, Aneek Ghosh, Syeda Vilay Zehra Rizvi, Neel Ajit Doshi, Hrishikesh Kommu, Yasar Sattar, Ashesh Das, Utkarsh Kohli","doi":"10.1111/pace.70445","DOIUrl":"https://doi.org/10.1111/pace.70445","url":null,"abstract":"<p><strong>Background: </strong>Femoral vascular access is integral to diagnostic and therapeutic electrophysiology (EP) procedures but is associated with bleeding and access-site complications. Manual compression and figure-of-eight sutures remain widely used for hemostasis; however, they are resource intensive and delay ambulation. Vascular closure devices (VCDs) have been introduced to facilitate rapid hemostasis and improve procedural efficiency, yet evidence specific to adult EP procedures remain conflicting.</p><p><strong>Objectives: </strong>To systematically evaluate the safety and efficacy of vascular closure devices compared with manual compression or figure-of-eight sutures for femoral access-site closure in adult electrophysiology procedures.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Scopus were searched from inception through January 2026. Randomized controlled trials and observational studies enrolling adults (≥ 18 years) undergoing diagnostic electrophysiology studies or catheter ablation with femoral access were included. Structural and valvular interventions were excluded. Random-effects meta-analyses were performed. Safety outcomes were summarized using risk ratios (RRs), and efficiency outcomes using standardized mean differences (SMDs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Eighteen studies (10 randomized controlled trials and 8 observational studies) involving 40,632 patients were included. Compared with manual compression, VCD was associated with significantly lower risks of access-site hematoma (RR, 0.59; 95% CI, 0.46-0.71), major bleeding (RR, 0.72; 95% CI, 0.55-0.88), minor bleeding (RR, 0.55; 95% CI, 0.17-0.93), and pseudoaneurysm formation (RR, 0.69; 95% CI, 0.54-0.83), with minimal heterogeneity for these outcomes. Absolute risk reductions were modest (number needed to treat: 90 for hematoma; 430 for pseudoaneurysm). VCDs significantly reduced time to hemostasis (SMD, -2.90; 95% CI, -3.71 to -2.08), time to ambulation (SMD, -1.84; 95% CI, -2.45 to -1.24), and time to hospital discharge (SMD, -1.12; 95% CI, -1.66 to -0.58), although heterogeneity for time-based outcomes was high. No significant differences were observed in infection or hospital readmission rates.</p><p><strong>Conclusions: </strong>In adult electrophysiology procedures, vascular closure devices are associated with modest reductions in access-site complications and substantial improvements in procedural efficiency. These findings support selective adoption of VCDs to optimize patient recovery and workflow, particularly in high-volume EP centers.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067280","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 of Pulsed Field Ablation: Established Evidence, Emerging Risks, and Knowledge Gaps.","authors":"Dakota de Cecco, Jeanne du Fay de Lavallaz, Boldizsar Kovacs, Jackson J Liang","doi":"10.1111/pace.70446","DOIUrl":"https://doi.org/10.1111/pace.70446","url":null,"abstract":"<p><p>Pulsed field ablation (PFA) has rapidly emerged as an important ablation technology for atrial arrhythmias and is increasingly being explored for ventricular arrhythmias. As clinical experience expands, a precise understanding of its safety profile is essential. This review summarizes contemporary evidence on the safety of PFA, distinguishes procedure-related complications from those attributable to electroporation, and highlights areas in which evidence remains limited.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043402","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":"Esophageal Temperature Changes During Pulsed Field Ablation With Three Catheter Systems.","authors":"Kanto Saida, Takunori Aoyama, Hitoshi Hirano, Noboru Ichihara","doi":"10.1111/pace.70439","DOIUrl":"https://doi.org/10.1111/pace.70439","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is considered less thermally injurious than conventional ablation technologies, but esophageal temperature elevation can still occur. Human data directly comparing esophageal temperature changes among different PFA catheter systems remain limited. We compared esophageal temperature changes during PFA using VARIPULSE, PulseSelect, and FARAPULSE.</p><p><strong>Methods: </strong>This retrospective single-center study included consecutive patients with nonvalvular atrial fibrillation who underwent pulmonary vein isolation using PFA with luminal esophageal temperature monitoring between April 2025 and March 2026. Esophageal temperature was measured at five sites every 0.5 s. For each patient, esophageal temperature rise (ΔT) was defined as the maximum esophageal temperature recorded during PFA minus the mean esophageal temperature during the 5-min interval immediately preceding the PFA application associated with that maximum temperature. A sensitivity analysis using the same ΔT definition was performed in patients who underwent pulmonary vein isolation alone.</p><p><strong>Results: </strong>A total of 70 patients were analyzed. ΔT differed among the three groups and was greatest with VARIPULSE (1.61 ± 1.00°C vs. 1.10 ± 0.61°C vs. 0.88 ± 0.43°C for VARIPULSE, PulseSelect, and FARAPULSE, respectively; p = 0.0302). In patients undergoing pulmonary vein isolation alone (n = 56), ΔT remained significantly different among the three groups (1.61 ± 1.03°C vs. 1.05 ± 0.61°C vs. 0.74 ± 0.38°C, respectively; p = 0.0386). Clinically significant temperature elevation (ΔT ≥ 2.0°C) occurred most frequently with VARIPULSE in both the overall cohort and the pulmonary vein isolation-only subgroup. Temperature elevation was most prominent during ablation near the left pulmonary veins and in anatomically adjacent regions to the esophagus. No patient developed symptoms suggestive of esophageal ulceration; however, systematic post-procedural endoscopic assessment was not performed.</p><p><strong>Conclusions: </strong>Measured esophageal temperature elevation during PFA differed according to catheter system and was greatest with VARIPULSE; this between-system difference persisted in patients undergoing pulmonary vein isolation alone. Because procedural characteristics differed among systems, these findings should not be interpreted as establishing a device-specific causal mechanism or esophageal safety.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043379","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":"Contact Strategies and Isolation Endpoints in Pulsed Field Ablation of Persistent Left Superior Vena Cava: A Case Series.","authors":"Lu Bai, Ruikun Jia, Xinmeng Wang, Jinling Fu, Kaijun Cui","doi":"10.1111/pace.70451","DOIUrl":"https://doi.org/10.1111/pace.70451","url":null,"abstract":"<p><p>Persistent left superior vena cava (PLSVC) can trigger atrial fibrillation. Thermal ablation of this vessel carries risks of phrenic nerve palsy and coronary artery spasm, whereas pulsed field ablation still lacks procedural guidance for the PLSVC diameter taper, which narrows from the distal segment to a dilated coronary sinus ostium. We report two contact strategies applied in three patients: a guidewire-anchored rail with steerable sheath tension for a fixed-loop catheter, and loop-diameter adjustment for a variable-loop catheter. Acute bidirectional block was confirmed by pacing in all three cases; in one case, dissociated spontaneous potentials provided an endpoint more stringent than atrial fibrillation termination alone. No complications occurred. These findings provide initial guidance for ablating the tapered PLSVC, although long-term durability requires prospective validation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043387","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}