Safety and performance of conduction system pacing: Real-world experience from a product surveillance registry.

Background: Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), has been used as an alternative for pacemaker indicated patients requiring ventricular pacing.

Objective: The purpose of this study was to characterize the safety and performance of HBP and LBBAP among patients enrolled in the Medtronic product surveillance registry (PSR).

Methods: This observational analysis included patients who underwent pacemaker implantations for HBP or LBBAP with a Medtronic Model 3830 lead between January 2019 and December 2023 in the Medtronic PSR.

His-Purkinje Conduction System Pacing Optimized Trial of Cardiac Resynchronization Therapy vs Biventricular Pacing: HOT-CRT Clinical Trial.

Background: His-Purkinje conduction system pacing (HPCSP) using His bundle pacing (HBP) or left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy (CRT).

Objectives: The aim of the study was to compare the feasibility and clinical efficacy of HOT-CRT (His-Purkinje conduction system pacing Optimized Trial of Cardiac Resynchronization Therapy) with BVP in patients with heart failure, reduced ejection fraction, and indication for CRT.

Methods: This was a prospective, randomized, controlled trial of HOT-CRT and BVP in patients with LVEF <50% and indications for CRT.

Coronary Venous Visualization During Deep Septal Lead Placement: An Unexpected Finding.

Left bundle branch area pacing has emerged as a safe and feasible alternative to conventional pacing. Acute septal injury, septal perforation, and arteriovenous fistula are potential risks of deep septal implants. Contrast drainage through the lesser cardiac veins and subsequent filling of major epicardial vessels may be benign observations noted during forceful hand injection.

Conduction system pacing versus conventional pacing in patients undergoing atrioventricular node ablation: Nonrandomized, on-treatment comparison.

Background: Atrioventricular node ablation (AVNA) with right ventricular or biventricular pacing (conventional pacing; CP) is an effective therapy for patients with refractory atrial fibrillation (AF). Conduction system pacing (CSP) using His bundle pacing or left bundle branch area pacing preserves ventricular synchrony.

Objective: The aim of our study is to compare the clinical outcomes between CP and CSP in patients undergoing AVNA.

Clinical outcomes of conduction system pacing compared to biventricular pacing in patients requiring cardiac resynchronization therapy.

Background: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is well-established therapy in patients with reduced left ventricular ejection fraction (LVEF) and bundle branch block or indication for pacing. Conduction system pacing (CSP) using His-bundle pacing (HBP) or left bundle branch area pacing (LBBAP) has been shown to be a safe and more physiological alternative to BVP.

Objective: The purpose of this study was to compare the clinical outcomes between CSP and BVP among patients undergoing CRT.

Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry.

Background: Left bundle branch area pacing (LBBAP) has been shown to be a feasible option for patients requiring ventricular pacing.

Objective: The purpose of this study was to compare clinical outcomes between LBBAP and RVP among patients undergoing pacemaker implantation METHODS: This observational registry included patients who underwent pacemaker implantations with LBBAP or RVP for bradycardia indications between April 2018 and October 2020. The primary composite outcome included all-cause mortality, heart failure hospitalization (HFH), or upgrade to biventricular pacing.

On-treatment comparison between corrective His bundle pacing and biventricular pacing for cardiac resynchronization: A secondary analysis of the His-SYNC Pilot Trial.

Background: The His-SYNC pilot trial was the first randomized comparison between His bundle pacing in lieu of a left ventricular lead for cardiac resynchronization therapy (His-CRT) and biventricular pacing (BiV-CRT), but was limited by high rates of crossover.

Objective: To evaluate the results of the His-SYNC pilot trial utilizing treatment-received (TR) and per-protocol (PP) analyses.

Methods: The His-SYNC pilot was a multicenter, prospective, single-blinded, randomized, controlled trial comparing His-CRT vs BiV-CRT in patients meeting standard indications for CRT (eg, NYHA II-IV patients with QRS >120 ms).

Percutaneous Closure of Persistent Atrial Septal Defects After Pulmonary Vein Isolation.

Pulmonary vein isolation (PVI) with radiofrequency or cryoballoon ablation to treat atrial fibrillation requires trans-septal puncture. This creates a small iatrogenic atrial septal defect (iASD). In most patients, the defect spontaneously closes after 3-6 months.

Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing.

Background: Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His bundle pacing (HBP) is a physiological alternative to RVP.

Objectives: This study sought to evaluate clinical outcomes of HBP compared to RVP.

Permanent His-bundle pacing: Long-term lead performance and clinical outcomes.

Background: Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His-bundle pacing (HBP) is a physiological alternative to RVP.

Objective: The purpose of this study was to report long-term performance and compare the clinical outcomes of permanent HBP vs RVP.

Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice.

Background: Right ventricular pacing (RVP) has been associated with heart failure and increased mortality. His-bundle pacing (HBP) is more physiological but requires a mapping catheter or a backup right ventricular lead and is technically challenging.

Objective: We sought to assess the feasibility, safety, and clinical outcomes of permanent HBP in an unselected population as compared to RVP.

Successful use of wearable cardioverter defibrillator in a patient with dextrocardia and persistent left superior vena cava.

Congenital disorders, such as dextrocardia and persistent left superior vena cava, are rare. However, their presence is often associated with other cardiac anomalies, and may lead to lethal ventricular tachyarrhythmias, which result in sudden cardiac death. Treating patients with these disorders can present a challenge to clinicians, as it may cause technical difficulties during interventional procedures, and more often, altered defibrillation techniques in a setting of prehospital sudden cardiac arrest.

Adenosine facilitates dormant conduction across cavotricuspid isthmus following catheter ablation.

Background: Recurrence of trans-isthmus conduction following catheter ablation of common right atrial flutter (AFL) has been reported to be as high as 15%-31% at 3 months with invasive follow-up. Intravenous adenosine has previously been shown to facilitate acute, transient reconnection of pulmonary veins following catheter ablation of atrial fibrillation.

Objective: To determine whether intravenous adenosine can facilitate dormant trans-isthmus conduction after achieving bidirectional conduction block (BDB) with catheter ablation.

Assessment of exit block following pulmonary vein isolation: far-field capture masquerading as entrance without exit block.

Background: Complete electrical isolation of pulmonary veins (PVs) remains the cornerstone of ablation therapy for atrial fibrillation. Entrance block without exit block has been reported to occur in 40% of the patients. Far-field capture (FFC) can occur during pacing from the superior PVs to assess exit block, and this may appear as persistent conduction from PV to left atrium (LA).

A novel approach to differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia.

Background: Various diagnostic maneuvers have been proposed to help differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentrant tachycardia (AVNRT) prior to ablation. However, not all criteria are applicable in every situation as each has limitations.

Objective: The purpose of this study was to determine whether the behavior of tachycardia during onset of right ventricular (RV) pacing would help differentiate ORT from AVNRT.

Cardiac tamponade as complication of active-fixation atrial lead perforations: proposed mechanism and management algorithm.

Background: Cardiac tamponade is a rare complication after implantation of dual chamber pacemaker or defibrillator systems. Its pathophysiology and optimal management are not currently well established.

Methods: Three cases of cardiac tamponade following successful implantation of transvenous dual chamber pacemakers with active-fixation atrial leads were identified.