His bundle combined with deep septal left bundle branch area pacing for atrial fibrillation prior to atrioventricular node ablation.

Background: To mitigate the risk of dyssynchrony-induced cardiomyopathy, international guidelines advocate His bundle pacing (HBP) with a ventricular backup lead prior to atrioventricular node ablation in treatment-refractory atrial fibrillation and normal left ventricular ejection fraction. As a result of concerns with long-term pacing parameters associated with HBP, this case series reports an adopted strategy of HBP combined with deep septal left bundle branch area pacing (dsLBBAP) in this patient cohort, enabling intrapatient comparison of the two pacing methods.

Methods And Results: Eight patients aged 72 ± 10 years (left ventricular ejection fraction 53 ± 4%) underwent successful combined HBP and dsLBBAP implant prior to AV node ablation.

Risk Factors of Haematoma Formation Following Cardiac Implantable Electronic Device Procedures.

Purpose: A single-centre cohort of 2,100 adults who consecutively underwent cardiac implantable electronic device procedures were retrospectively analysed to identify and quantify risk factors of perioperative pocket haematoma formation.

Results: Dual antiplatelet therapy was significantly associated with increased odds of haematoma formation (OR 11.7 for aspirin and clopidogrel, OR 11.

Cardiac Society of Australia and New Zealand (CSANZ) Position Statement on the Follow-Up of Cardiovascular Implantable Electronic Devices 2022.

Recognising the need for a national approach for the recommended best practice for the follow-up of implanted cardiac rhythm devices to ensure patient safety, this document has been produced by the Cardiac Society of Australia and New Zealand (CSANZ). It draws on accepted practice standards and guidelines of international electrophysiology bodies. It lays out methodology, frequency, and content of follow-up, including remote monitoring; personnel, including physician, allied health, nursing and industry; paediatric and adult congenital heart patients; and special considerations including magnetic resonance imaging scanning, perioperative management, and hazard alerts.

Left bundle branch area pacing in congenitally corrected transposition of great arteries - The obvious choice?

Patients with congenitally corrected transposition of the great arteries (CCTGA) are susceptible to acquired atrioventricular conduction disease in early life. Emerging studies propose that conduction system pacing either by His bundle pacing or bundle branch pacing is advantageous in this population. The anatomical abnormality of CCTGA conveniently positions the left bundle branches on the easily accessible right ventricular septal side.

Remote Device Interrogation Kiosks (ReDInK) - Pharmacy Kiosk Remote Testing of Pacemakers and Implantable Cardioverter-Defibrillators for Rural Victorians. A Novel Strategy to Tackle COVID-19.

Background: In the era of COVID-19, travel restrictions and social distancing measures have changed the landscape for device interrogations of pacemakers and defibrillators for rural Victorians. Previously, device checks were performed infrequently in large volume, face-to-face rural clinics by visiting cardiologists and technicians. Access to remote areas and social distancing restrictions have made these clinics unfeasible to operate.

Learning Curve and Initial Experience With Implementation of a His-Bundle Pacing Program in an Australian Setting.

Background: His-bundle pacing (HBP) has emerged as a promising technique to avoid pacing complications associated with dyssynchrony from right ventricular pacing, but data are limited to experienced operators and centres. We aimed to evaluate the implementation and outcomes of an HBP program in an Australian setting.

Methods: Data were retrospectively collected on 140 consecutive HBP procedures attempted at three centres from March 2018 to September 2019.

Cardiac rhythm management devices.

Background: The last decade has seen ongoing evolution and use of cardiac rhythm management devices, including pacemakers, cardiac resynchronisation therapy, implantable cardioverter defibrillators and loop recorders. General practitioners are increasingly involved in follow-up and management of patients with these devices.

Objective: The aim of this article is to provide an overview of different cardiac rhythm management devices, including their role, implant procedure, post-procedural care, potential complications and follow‑up.

Effects of long-term ω-3 polyunsaturated fatty acid supplementation on paroxysmal atrial tachyarrhythmia burden in patients with implanted pacemakers: results from a prospective randomised study.

Background: Sino-atrial node disease and aging increase AF risk. We investigated if long-term fish oil supplementation reduces paroxysmal atrial tachycardia/fibrillation (AT/AF) burden in patients aged ≥60 years with sinoatrial node disease and dual chamber pacemakers.

Methods: Following a run-in period of 6 months (p1) where AT/AF burden was logged,78 patients were randomised to control or fish oil group (total omega-3 6 g/d) and AT/AF burden evaluated after 6 months (p2; 39 controls, 39 fish oil) and 12 months (p3; 39 controls; 18 fish oil).

Atrial electrophysiology is altered by acute hypercapnia but not hypoxemia: implications for promotion of atrial fibrillation in pulmonary disease and sleep apnea.

Background: Chronic pulmonary disease and sleep apnea have been associated with the development of atrial fibrillation (AF).

Objective: The purpose of this study was to characterize the atrial electrical changes that occur with hypercapnia and hypoxemia and to determine their role in AF development.

Methods: Seventeen sheep (6 control, 5 hypercapnia, 6 hypoxemia) underwent open chest electrophysiologic evaluation under autonomic blockade.

The role of chronic atrial stretch and atrial fibrillation on posterior left atrial wall conduction.

Background: The posterior left atrium (LA) is involved in the initiation and maintenance of atrial fibrillation (AF).

Objective: The purpose of this study was to compare conduction patterns on the posterior LA in patients with mitral regurgitation (MR), with and without AF.

Methods: Epicardial mapping of the posterior LA was performed in 23 patients undergoing cardiac surgery.

Fractionated atrial electrograms during sinus rhythm: relationship to age, voltage, and conduction velocity.

Background: Fractionated atrial electrograms (CFAEs) have been implicated in the mechanism of atrial fibrillation (AF). The prevalence and distribution of CFAEs in normal populations have not been clearly defined.

Objective: This study sought to determine the influence of age on CFAEs and investigate the relationship between CFAEs and the underlying atrial substrate.

Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function.

Aims: Recent studies have suggested an emerging link between sleep apnoea and atrial fibrillation (AF). These studies included patients with reduced left ventricular (LV) function which may cause both AF and sleep disordered breathing (SDB). We examined the prevalence of SDB in a population of patients with AF and normal LV function.

Anatomically determined functional conduction delay in the posterior left atrium relationship to structural heart disease.

Objectives: This study sought to characterize the conduction properties of the posterior left atrium (PLA) in patients with different forms of structural heart disease undergoing cardiac surgery.

Background: The PLA plays an important role in the initiation and maintenance of atrial fibrillation.

Methods: This study included 34 patients having elective cardiac surgery.

The right ventricular outflow tract: a comparative study of septal, anterior wall, and free wall pacing.

Background: There is marked heterogeneity in right ventricular outflow tract (RVOT) pacemaker lead placement using conventional leads. As a result, we have sought to identify a reproducible way of placing a ventricular lead onto the RVOT septum.

Methods And Results: A major determinant is the shape of the stylet used to deliver the active-fixation lead.

The right ventricular outflow tract: the road to septal pacing.

Background: Pacing from the right ventricular apex is associated with long-term adverse effects on left ventricular function. This has fuelled interest in alternative pacing sites, especially the septal aspect of the right ventricular outflow tract (RVOT). However, it is a common perception that septal RVOT pacing is difficult to achieve.

Focal atrial tachycardias arising from the right atrial appendage: electrocardiographic and electrophysiologic characteristics and radiofrequency ablation.

Objective: To characterize the electrocardiographic and electrophysiological features and frequency of focal atrial tachycardia (AT) originating from the right atrial appendage (RAA).

Background: The RAA has been described as a site of origin of AT, but detailed characterization of these tachycardias is limited.

Methods: Ten patients (3.

Right ventricular outflow tract pacing: radiographic and electrocardiographic correlates of lead position.

Objective: To characterize the pacing site in an unselected series of patients undergoing right ventricular outflow tract (RVOT) lead placement and investigate the role of the electrocardiogram (ECG) in predicting implantation.

Background: Right ventricular apical pacing is associated with long-term adverse effects on left ventricular function, fuelling interest in alternative pacing sites, especially the RVOT. Previous studies have been conflicting, possibly due to poor definition of pacing site within the RVOT.

A grave case of bradycardia.

Tachycardia is a prominent feature of thyrotoxicosis. We present an unusual case of Graves' thyrotoxicosis presenting as profound symptomatic bradycardia.

A coroner's request for closure: the value of the stored electrogram.

Pacemaker diagnostics can be useful to troubleshoot both during life and after death. A 58-year old man with a single chamber ventricular pacemaker and a previous His bundle ablation died suddenly. Interrogation of his pacemaker revealed the cause of death not as pacemaker malfunction, but a fatal ventricular arrhythmia.

Scar-related right atrial macroreentrant tachycardia in patients without prior atrial surgery: electroanatomic characterization and ablation outcome.

Background: Few descriptions of right atrial macroreentrant atrial tachycardia involving regions of spontaneous "scar" have been reported.

Objectives: We describe the electrocardiographic, electrophysiologic, and electroanatomic characteristics of an unusual RA macroreentrant atrial tachycardia in eight patients with spontaneous RA scarring.

Methods: Eight of 286 patients with macroreentrant atrial tachycardia treated with radiofrequency ablation had RA spontaneous scarring and underwent conventional electrophysiologic studies and electroanatomic mapping.

Focal atrial tachycardia from the ostium of the coronary sinus: electrocardiographic and electrophysiological characterization and radiofrequency ablation.

Objectives: The goal of this study was to characterize the electrocardiographic and electrophysiologic features and frequency of focal atrial tachycardia (AT) originating from the coronary sinus ostium (CS).

Background: The ostium of the coronary sinus has been described as a site of origin of AT, but detailed characterization of these tachycardias is limited.

Methods: Thirteen patients (6.