BACKGROUND: This case report highlights the novel role of His-bundle pacing (HBP) from right atrium, not just for preserving cardiac function, but also for avoiding interference with TriClip devices.
RESULTS: A 78-year-old female with severe tricuspid regurgitation received two TriClip devices. Postprocedure, frequent significant sinus pauses required a pacemaker. HBP was chosen to avoid lead complications. Under local anesthesia, a His pacing lead was inserted via the axillary vein using specialized catheter. Follow-ups over 2.5 years showed stable parameters with no complications.
CONCLUSIONS: HBP is effective for patients with TriClip devices, ensuring optimal cardiac function and lead stability.

Left bundle branch pacing has recently emerged as a significant alternative to right ventricular pacing. The rate of implanted stylet-driven septal leads is expected to increase substantially in the coming years, along with the need to manage long-term complications. Experience in extracting these leads is currently very limited; however, the number of complex extractions is anticipated to increase in the future. We report a complex case involving the extraction of a long-dwelling Solia lead used for left bundle branch pacing in a 21-year-old man. The lead was extracted through the implant vein 27 months after implantation, using a methodology that involved a locking stylet and compression coil. The new lead insertion was challenging due to venous occlusion but after successful venoplasty, the His lead was successfully implanted. The postoperative course was uneventful, demonstrating the feasibility of extraction without complications.

Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are comorbid conditions that are increasingly prevalent and have a high socioeconomic burden. This article discusses their shared pathophysiology, focusing on the triad of hypertension, obesity, and aging. We highlight the misperception that pharmacologic heart rate lowering is beneficial, which has resulted in an overprescription of beta-blockers in HFpEF and AF. In contrast, heart rate modulation through accelerated pacing provides hemodynamic and structural advantages, which have yielded significant improvements in quality of life, physical activity, and AF burden in the myPACE trial of patients with preclinical or overt HFpEF.

暂无摘要。

The authors report for the first time to their knowledge, implantation of a standard implantable cardioverter-defibrillator lead for permanent delivery of left bundle branch area pacing. Implantation was successful and safe in 11 of 12 patients, with adequate defibrillation testing, good electrical and electrocardiographic parameters, and uneventful device-related short-term follow-up.

Persistent left superior vena cava (PLSVC) is one of the anatomical variations, which can make device implantation more challenging and lead to incorrect lead placement, dislodgement, and procedure failure. Conduction system pacing (CSP) can be an alternative to traditional CRT implantation. Herein, we describe a brief case report of successful LBBAP-optimized CRT (LOT-CRT) via an innominate vein in a patient with PLSVC.

Conduction system pacing (CSP) has emerged as an alternative to cardiac resynchronization therapy (CRT); however, there is limited experience with CSP using implantable cardiac defibrillator (ICD) leads. The achievement of CSP with an ICD lead may yield comparable results to cardiac resynchronization therapy defibrillator (CRT-D) therapy using fewer leads. We implanted the Biotronik Linox DX \"VDD\"-programmable ICD lead in a swine model to investigate the feasibility of \"single-lead\" CRT-D implantation. With the lead embedded in the basal right ventricular septum, morphologic criteria for CSP were achieved, and successful defibrillation was performed while maintaining atrial sensing. Future work may assure reproducibility of these findings and further determine the feasibility of a single-lead CRT-D.

BACKGROUND: Although output-dependent QRS transition is a specific indicator that confirms left bundle branch (LBB) capture during left bundle branch area pacing (LBBAP), its durability remains unclear.
OBJECTIVE: To evaluate the presence of output-dependent QRS transition and capture thresholds of the LBB and left ventricular septal myocardium (LVS) immediately and up to 1 year after the LBBAP procedure.
METHODS: We enrolled 129 patients with successful LBBAP who were available for 1-year follow-up postoperatively. Threshold testing was performed immediately after LBBAP on postoperative day 0 (POD-0), after three days (POD-3), 6 months (POD-180), and 1 year (POD-360).
RESULTS: Output-dependent QRS transition persisted in 64 (88%) patients on POD-360, from amongst the 73 patients with output-dependent QRS transition on POD-0. In contrast, 55 (98%) of 56 patients without QRS transition on POD-0 did not exhibit QRS transition thereafter. LBB thresholds were slightly elevated on POD-360, albeit without statistical significance, compared to those on POD-0 (1.22 ± 1.00 vs. 1.43 ± 1.29 V at 0.4 ms, p=0.26). The LBB thresholds increased by ≥1.5 V in 7 (11%) patients. However, in 93% of patients with an LBB threshold of ≤2.5 V on POD-0, LBB capture was maintained at 2.5 V on POD-360. LVS thresholds were similar on POD-0 and POD-360 (0.81 ± 0.36 vs. 0.83 ± 0.24 V, p=1.0), and did not increase by ≥1.5 V in any patient.
CONCLUSIONS: Output-dependent QRS transitions were highly reproducible after implantation. Furthermore, LBB thresholds remained stable in most cases during the first postoperative year.

BACKGROUND: Biventricular pacing (BVP) appears to confer more pronounced advantages in women, yet the impact of conduction system pacing (CSP) remains insufficiently characterized. This investigation seeks to elucidate sex-specific disparities in clinical outcomes among patients with typical left bundle branch block (LBBB) undergoing CSP, with a particular focus on assessing contributory factors.
METHODS: Consecutive patients diagnosed with nonischemic cardiomyopathy, exhibiting left ventricular ejection fraction (LVEF) ≤ 40%, and manifesting typical LBBB as Strauss criteria, underwent CSP. Subsequent longitudinal monitoring assessed improvements in LVEF and the composite endpoint of mortality or heart failure hospitalization (HFH).
RESULTS: Among the included 176 patients, women (n = 84, mean age: 69.5 ± 8.8 years) displayed smaller heart size (LVEDd, 62.0 ± 8.3 mm vs. 64.8 ± 7.9 mm, P = 0.023) and shorter baseline QRSd (163.5 ± 17.7 ms vs. 169.7 ± 15.1 ms; P = 0.013) than men. Of the 171 patients who completed the follow-up, super-response was observed in 120 (70%), with a higher occurrence in women than men (78.3% vs. 62.5%, P = 0.024). The incidence of death or HFH was numerically lower in women (7.1% Vs 13%, Log-rank P = 0.216). Notably, the super-response showed a significant difference in women compared to men at the same electrocardiography and/or echocardiographic parameters value. Mediation analysis between sex and super-response revealed that LVEDd and pQRSd play an intermediary role, with the mediation proportion of 26.07% and 27.98%, respectively.
CONCLUSIONS: Women may derive more benefits from CSP, and pQRSd and LVEDd partly drive this difference.

A left bundle pacing stimulation pacemaker was implanted using stylet driver lead. The screw incarceration occurred after positioning of the lead. The screw rupture occurred during lead retraction; the distal portion of the screw remained incarcerated at the interventricular septum.