Conduction System Pacing With Stylet Driven Leads: A Step-By-Step Guide to Implant.

Background: In recent years, there has been a surge of interest in strategies to perform conduction system pacing (CSP). Of these, left bundle branch area pacing (LBBAP) has rapidly gained popularity as the preferred approach to perform CSP due to favorable pacing thresholds and greater perceived ease of implant.

Aim: The majority of initial descriptions of LBBAP has focused on use of lumenless pacing leads.

The evolution of conduction system pacing and gaps in understanding.

The field of cardiac pacing has changed dramatically since the first pacemakers were implanted in the 1950s. Over the ensuing decades, advancements in pacing technology have yielded longer battery life, smaller devices, sturdier leads, and more sophisticated pacemaker programming. Cardiac resynchronization therapy (CRT) represented a significant revolution in pacing approach, with the goal of correcting interventricular dyssynchrony through biventricular pacing.

Cardioneural Ablation for Functional Bradycardia and Vasovagal Syncope: Outcomes From the U.S. Multicenter CNA Registry.

Background: Cardioneural ablation (CNA) shows promise as a viable alternative to permanent cardiac pacing and pharmacotherapy for patients with symptomatic functional bradycardia and debilitating vasovagal syncope (VVS). The evidence supporting a potential therapeutic role for CNA is limited by relatively small sample sizes from predominantly single-center reports.

Objectives: This study sought to report the feasibility, safety, and clinical efficacy of CNA from a large, first-ever multicenter US registry.

Leadless Atrial Pacing Targeting Bachmann's Bundle for Atrial Resynchronization.

Background: Leadless pacemakers have transformed pacing by reducing risk for infection and lead-related complications. The feasibility of achieving leadless Bachmann's bundle area pacing (BBAP) for atrial resynchronization is not known.

First-in-human Summary: A 49-year-old woman with sinus node dysfunction and interatrial conduction delay underwent leadless atrial pacemaker targeting Bachmann's bundle (BB).

Left bundle branch area pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with left ventricular ejection fraction ≤50%: Results from the International Collaborative LBBAP Study (I-CLAS).

Background: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is an established treatment of heart failure with reduced ejection fraction and wide QRS. Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative by directly engaging the His-Purkinje system, potentially improving electrical resynchronization and clinical outcomes.

Objective: The aim of the study was to compare the clinical outcomes between BVP and LBBAP in patients with left ventricular ejection fraction (LVEF) ≤50% undergoing CRT.

Echocardiographic response from left bundle branch area pacing optimized cardiac resynchronization therapy (LOT-CRT) vs traditional CRT.

Background: Traditional cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) may be less effective in patients with nonspecific intraventricular conduction delay (NIVCD). Left bundle branch area pacing (LBBAP) combined with left ventricular (LV) coronary venous lead pacing (LOT-CRT) may be more effective in these patients.

Objective: We assessed the echocardiographic response of LOT-CRT in patients with left bundle branch block (LBBB) or NIVCD and compared it with a propensity-matched BVP cohort.

Association of air pollution with ventricular arrhythmias and physical activity: A natural experiment from US wildfires.

Background: The association between particulate matter (PM) air pollution and ventricular arrhythmias is not well established. In patients with cardiac implantable electronic devices (CIEDs), publicly available day-level air pollution data provide a unique opportunity to study acute and subacute effects of PM pollution.

Objective: The purpose of this study was to evaluate the association of air pollution with ventricular arrhythmias, physical activity, and CIED markers of heart failure.

Performance of an active fixation stylet-driven lead in left bundle branch area pacing: Results from INSIGHT-LBBA.

Background: Left bundle branch area pacing (LBBAP) has been rapidly adopted despite a lack of leads with approved indications for LBBAP.

Objective: This study aims to analyze the performance of a 6Fr active fixation, stylet-driven lead in LBBAP.

Methods: The multicenter INSIGHT-LBBA registry analyzed consecutive LBBAP implant attempts with INGEVITY+ leads.

Permanent Left Bundle Branch Area DF-4 Defibrillator Lead Implantation-Feasibility, Procedural Caveats, Safety, and Follow-Up.

Introduction: Permanent implantation of a DF-4 implantable cardiac defibrillator (ICD) lead in the left bundle branch area (LBBA-ICD) is the next paradigm in amalgamating cardiac resynchronization therapy (CRT) and defibrillation. We systematically investigated feasibility/success rate, procedural caveats, and complications associated with a permanent DF-4 LBBA ICD implant and pertinent data at short-term follow-up.

Methods: We prospectively attempted implantation of 7 Fr Durata (Abbott, Chicago, IL, USA) single coil DF-4 ICD lead at the LBBA using a fixed-curve non-deflectable CPS locator delivery sheath.

Electrophysiological predictors of susceptible atrial substrate for the onset and recurrence of atrial fibrillation.

Background: The atrial electroanatomic substrate is an essential component in the pathogenesis of atrial fibrillation (AF). However, the electrophysiological markers of susceptible atria for AF are not well-characterized. This study aimed to assess atrial conduction indices on surface electrocardiogram (ECG) and intracardiac electrogram (EGM) as predictors of initiation and recurrence of AF after successful ablation.

Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with heart failure and mildly reduced left ventricular ejection fraction: Results from International Collaborative LBBAP Study (I-CLAS) Group.

Background: Cardiac resynchronization therapy (CRT) is a guideline-recommended therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF, 36%-50%) and left bundle branch block or indication for ventricular pacing. Conduction system pacing (CSP) using left bundle branch area pacing or His bundle pacing has been shown to be a safe and physiologic alternative to biventricular pacing (BVP).

Objective: The aim of this study was to compare the clinical outcomes between BVP and CSP for patients with HFmrEF undergoing CRT.

Rate-Dependent Pacemap Matching in Scar-Related Ventricular Tachycardia: Impact of "TR Fusion" Phenomenon.

Background: The impact of varying rates of pacemapping (PM) rates on QRS morphology and PM score matching in patients with scar-related ventricular tachycardia (VT) has not been systematically assessed.

Objectives: In this study, the authors sought to assess the variability in PM score matching at different pacing rates.

Methods: During substrate mapping for VT ablation, PM was performed at cycle lengths (CLs) of 600 ms, 500 ms, 400 ms, 300 ms, and VT CL.

Comparing outcomes after pulmonary vein isolation in patients with systolic and diastolic heart failure.

Background: The benefit of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) is well established; its efficacy in patients with heart failure preserved ejection fraction (HFpEF) is less clear.

Objective: The objective of the study was to compare AF and heart failure (HF) rehospitalizations after PVI in patients with HFpEF vs HFrEF.

Methods: The IBM MarketScan Database was used to identify patients undergoing PVI for AF.

Clinical outcomes of conduction system pacing compared to biventricular pacing in patients with mid-range ejection fraction.

Background: There is a paucity of data comparing conduction system pacing (CSP) to biventricular pacing (BiVP) in patients with heart failure (HF) with mid-range left ventricular ejection fraction (LVEF).

Objective: Compare the clinical outcomes of patients with mid-range LVEF undergoing CSP versus BiVP.

Methods: Patients with mid-range LVEF (> 35 to 50%) undergoing CSP or BiVP were retrospectively identified.

Predictors of Shock-Reduction Programming and Its Impact on Implantable Cardioverter-Defibrillator Therapies and Mortality: The CERTITUDE Registry.

Background: Shock-reduction implantable cardioverter-defibrillator programming (SRP) was associated with fewer therapies and improved survival in randomized controlled trials, but real-world studies investigating SRP and associated outcomes are limited.

Methods And Results: The BIOTRONIK CERTITUDE registry was linked with the Medicare database. We included all patients with an implantable cardioverter-defibrillator implanted between August 22, 2012 and September 30, 2021 in the United States.