Lead Management in Special Scenarios.

In this article, the authors review the approach to infections associated with surgically placed leads, leads placed in unusual locations such as azygous veins, extraction of active fixation coronary sinus leads, and the role of hybrid extractions in difficult cases. The authors also review strategies to mitigate the risk of paradoxic embolism among patients undergoing transvenous lead extraction.

Atrial Fibrillation Substrate and Catheter Ablation Outcomes in MYBPC3- and MYH7-Mediated Hypertrophic Cardiomyopathy.

Background: The effects of disease-causing MYBPC3 or MYH7 genetic variants on atrial myopathy, atrial fibrillation (AF) clinical course, and catheter ablation efficacy remain unclear.

Objectives: The aim of this study was to characterize the atrial substrate of patients with MYBPC3- or MYH7-mediated hypertrophic cardiomyopathy (HCM) and its impact on catheter ablation outcomes.

Methods: A retrospective single-center study of patients with HCM who underwent genetic testing and catheter ablation for AF was performed.

Cardiac resynchronization therapy for patients with mild to moderately reduced ejection fraction and left bundle branch block.

Background: It is unknown whether cardiac resynchronization therapy (CRT) would improve or halt the progression of heart failure (HF) in patients with mild to moderately reduced ejection fraction (HFmmrEF) and left bundle branch block (LBBB).

Objective: This study aimed to investigate the outcomes of CRT in patients with HFmmrEF and left ventricular conduction delay.

Methods: A prospective, randomized clinical trial sponsored by the National Heart, Lung, and Blood Institute included 76 patients who met the study inclusion criteria (left ventricular ejection fraction [LVEF] of 36%-50% and LBBB).

Left bundle branch pacing vs ventricular septal pacing for cardiac resynchronization therapy.

Background: The outcomes of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) in patients with heart failure remain to be learned.

Objective: The objective of this study was to assess the echocardiographic and clinical outcomes of LBBP, LVSP, and deep septal pacing (DSP).

Methods: This retrospective study included patients who met the criteria for cardiac resynchronization therapy (CRT) and underwent attempted LBBP in 5 Mayo centers.

Trends in the 30-year span of noninfectious cardiovascular implantable electronic device complications in Olmsted County.

Background: Cardiac implantable electronic devices (CIEDs), such as permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices, alleviate morbidity and mortality in various diseases. There is a paucity of real-world data on CIED complications and trends.

Objectives: We sought to describe trends in noninfectious CIED complications over the past 3 decades in Olmsted County.

Long-term outcomes with abandoning versus extracting sterile leads: A 10-year population-based study.

Background: Long-term outcomes of sterile lead management strategies of lead abandonment (LA) or transvenous lead extraction (TLE) remain unclear.

Methods: We performed a retrospective study of a population residing in southeastern Minnesota with follow-up at the Mayo Clinic and its health systems. Patients who underwent LA or TLE of sterile leads from January 1, 2000, to January 1, 2011, and had follow-up for at least 10 years or until their death were included.

First-in-man report of transsubclavian venous implantation of the Aveir leadless cardiac pacing system.

Introduction: Transsubclavian venous implantation of the Aveir leadless cardiac pacemaker (LCP) has not been previously reported.

Methods And Results: Three cases of transsubclavian implantation of the Aveir LCP are reported. Two cases were postbilateral orthotopic lung transplant, without appropriate femoral or jugular access due to recent ECMO cannulation and jugular central venous catheters.

Cardiac implantable electronic devices in female patients: Esthetic, breast implant, and anatomic considerations.

Introduction: The implantation of a cardiac implantable electronic device (CIED) can have esthetic and psychological consequences on patients. We explore a heart team model for care coordination and discuss esthetic approaches for improved cosmetic outcomes in patients undergoing (CIED)-related procedures or de novo implantation.

Methods: Patients undergoing CIED surgery for approved indications between June 2015 and June 2022 were identified.

Incidence and Outcomes of New-Onset Right Bundle Branch Block Following Transcatheter Aortic Valve Replacement.

Background: The incidence and prognosis of right bundle branch block (RBBB) following transcatheter aortic valve replacement (TAVR) are unknown. Hence, we sought to characterize the incidence of post-TAVR RBBB and determine associated risks of permanent pacemaker (PPM) implantation and mortality.

Methods: All patients 18 years and above without preexisting RBBB or PPM who underwent TAVR at US Mayo Clinic sites and Mayo Clinic Health Systems from June 2010 to May 2021 were evaluated.

Trends in the 30-year span of Noninfectious Cardiovascular Implantable Electronic Device Complications in Olmsted County.

Background: Cardiovascular implantable electronic devices (CIEDs) such as permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices alleviate morbidity and mortality in various diseases. There is a paucity of real-world data on CIED complications and trends.

Objectives: Describe trends in noninfectious CIED complications over the past three decades in Olmsted County.

Causes of Early Mortality After Catheter Ablation of Atrial Fibrillation.

Background: Recognition of the causes of early mortality after atrial fibrillation (AF) catheter ablation is essential for the improvement of patient safety. This study sought to determine the causes of early mortality (≤90 days) after AF ablation.

Methods: We performed a retrospective analysis of AF ablation from January 1, 2013, to December 1, 2021 at the Mayo Clinic (Rochester, Phoenix, and Jacksonville).

Subcutaneous implantable cardioverter-defibrillator noise following left ventricular assist device implantation.

Background: The incidence and impact of noise in a subcutaneous implantable cardioverter defibrillator (S-ICD) after left ventricular assist device (LVAD) implantation is not well established.

Methods: We performed a retrospective study of patients implanted with LVAD and with a pre-existing S-ICD between January 2005 and December 2020 at the three Mayo Clinic centers (Minnesota, Arizona, and Florida).

Results: Of the 908 LVAD patients, a pre-existing S-ICD was present in 9 patients (mean age 49.

Ventricular arrhythmias in patients with prior aortic valve intervention: Characteristics, ablation and outcomes.

Introduction: Data regarding ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation in patients with aortic valve (AV) intervention (AVI) is limited. Catheter ablation (CA) can be challenging given perivalvular substrate in the setting of prosthetic valves. We sought to investigate the characteristics, safety, and outcomes of CA in patients with prior AVI and ventricular arrhythmias (VA).

A Data-Driven Preprocessing Framework for Atrial Fibrillation Intracardiac Electrocardiogram Analysis.

Atrial Fibrillation (AF) is the most common cardiac arrhythmia. Signal-processing approaches are widely used for the analysis of intracardiac electrograms (iEGMs), which are collected during catheter ablation from patients with AF. In order to identify possible targets for ablation therapy, dominant frequency (DF) is widely used and incorporated in electroanatomical mapping systems.

One-year outcomes of catheter ablation for atrial fibrillation in young patients.

Background: Atrial fibrillation (AF) is relatively less frequent in younger patients (age < 50). Recently, studies have suggested that early restoration of sinus rhythm may lead to improved outcomes compared with rate control, however the efficacy of catheter ablation for AF in young is scarce.

Methods: We included all hospitalized patients between 18 and 50 years with a diagnosis of AF from the Nationwide Readmission Database 2016-2017 from the Healthcare Cost and Utilization Project.

Causes of Early Mortality After Transvenous Lead Removal.

Background: Recognition of the causes of early mortality (≤30 days) after transvenous lead removal (TLR) is an essential step for the development of quality improvement programs.

Objectives: This study sought to determine the causes of early mortality after TLR and to further understand the circumstances surrounding death after TLR.

Methods: A retrospective analysis was performed of all patients undergoing TLR from January 1, 2001, to January 1, 2021, at the Mayo Clinic (Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida).

Causes of Early Mortality After Ventricular Tachycardia Ablation in Patients With Reduced Ejection Fraction.

Background: Recognition of the causes of early mortality after ventricular tachycardia (VT) ablation in patients with reduced left ventricular ejection fraction (LVEF) is an essential step toward improving postprocedural outcomes.

Objectives: This study sought to determine the causes of early mortality (≤30 days) after VT ablation in patients with reduced LVEF and to understand further the circumstances surrounding death after the procedure.

Methods: We performed a retrospective analysis of all patients undergoing VT ablation in patients with reduced LVEF from January 1, 2013, to November 10, 2021, at the Mayo Clinic (Rochester, Phoenix, and Jacksonville).