ABSTRACT Background Bioelectric impedance analysis (BIA) is a useful clinical tool in pediatric heart disease, but concerns regarding cardiac implanted electronic devices (CIEDs) limit its use. This study's goal was to assess the impact of BIA on CIED settings in pediatric patients. Methods This single‐center cohort study included two groups: a retrospective cohort of patients under 21 years old who had CIED interrogation within 12 months before and after BIA use, and a smaller prospective cohort who had CIED interrogation immediately before and after BIA use. The prospective group also underwent real‐time monitoring for electrical interference during BIA. Exclusion criteria included age, implanted loop recorders, and incomplete data. Analysis used either a paired t ‐test or a Wilcoxon signed‐rank test as appropriate, with p ‐value < 0.05 considered statistically significant. Results The retrospective cohort included 55 patients with 80 total tests. A statistically but not clinically significant difference in lead impedance was observed (513 [456, 627] v 513 [399, 593] ohms, p < 0.0001), though no differences were found in electrogram amplitudes, thresholds, or programmed output. When patients with multiple tests were analyzed, there remained a statistically significant difference in lead impedance (513 [399, 614] v 513 [375, 592] ohms, p = 0.0002) but not in other CIED parameters. In the prospective cohort ( n = 10), no electrical interference was appreciated during BIA, and there were no before‐and‐after differences in CIED sensing amplitudes. No inappropriate shocks or premature device failures occurred. Conclusions BIA was not associated with adverse events or meaningful changes in CIED function in this pediatric cohort.
Abstract Background Registry studies from 2000–2010 demonstrated underutilization of primary prevention ICD therapy. As heart failure therapies have reduced sudden cardiac death, investigators have questioned guidelines derived from trials conducted two decades prior, particularly in non‐ischemic cardiomyopathy (NICM) and elderly subgroups. We characterized contemporary referral determinants, decision‐making processes, and outcomes of primary prevention ICD therapy in a diverse, under‐represented population. Methods In this retrospective single‐center cohort study, we reviewed records of all patients meeting Class I criteria for primary prevention ICD in 2019. Multivariable logistic regression identified factors associated with ICD referral, and time‐varying Cox models compared all‐cause mortality by implantation status through 2022. Results Of 559 eligible patients, 345 (62%) were referred and 227 (41%) underwent implantation. Referral was associated with male gender, care coordination by a cardiologist rather than a generalist, and lower social vulnerability index (SVI) score. No decision‐making rationale was documented for a plurality of non‐referred and non‐implanted patients; documented rationales identified potential intervention targets. ICD implantation was not associated with all‐cause mortality (aHR 0.74, 95% CI 0.49–1.12). In exploratory analyses stratified by cardiomyopathy type, implantation was associated with lower mortality in ischemic cardiomyopathy (aHR 0.51, 95% CI 0.27–0.95) but not in NICM (aHR 1.11, 95% CI 0.63–1.95). Conclusion Many eligible patients are never referred for ICD therapy. Female gender, generalist care coordination, and high SVI were associated with non‐referral. The exploratory association of implantation with lower mortality in ischemic cardiomyopathy was not significant in propensity score overlap‐weighted analyses. The NICM estimate was imprecise.
ABSTRACT Background Atrial fibrillation (AF) remains a challenging arrhythmia to manage, and catheter ablation is a cornerstone therapy. Pulsed Field Ablation (PFA) has recently emerged as a novel non‐thermal alternative to Contact Force Radiofrequency (CF‐RF) ablation. This meta‐analysis compares the efficacy, safety, and procedural efficiency of PFA versus CF‐RF in patients with persistent atrial fibrillation. Methods A systematic review and meta‐analysis were conducted using randomized controlled trials and cohort studies identified from MEDLINE, Embase, and Cochrane databases. Primary outcomes included 12‐month freedom from atrial arrhythmia (AF, atrial flutter, or atrial tachycardia), procedure duration, fluoroscopy time, and major complications. Subgroup analyses were performed based on PFA device type (Farapulse vs. HT‐9000Pro) and patient characteristics, including left atrial size and AF duration. Results Seventeen studies met inclusion criteria. PFA was associated with significantly higher 12‐month freedom from atrial arrhythmia compared with CF‐RF (OR = 1.36, 95% CI 1.26–1.47, p < 0.001). Procedure time was markedly shorter with PFA (MD = −40.5 minutes, p < 0.001), while fluoroscopy time also showed a significant reduction (MD = −1.8 minutes, p = 0.001). Major complications were significantly lower with PFA (1.2% vs. 2.8%; OR = 0.44, 95% CI 0.35–0.57, p < 0.001). Conclusion In persistent AF, PFA, demonstrates superior efficacy, safety, and procedural efficiency compared with CF‐RFA, supporting its role as a potential first‐line ablation strategy. Larger multicenter trials with long‐term follow‐up are needed to confirm durability and device‐specific outcomes.
ABSTRACT Leadless pacing is an important option for patients with device‐related infections. In those requiring dual‐chamber support, reduced atrial battery longevity due to continuous implant‐to‐implant (i2i) communication remains a concern. While recent software updates now allow for the disablement of i2i communication when clinically appropriate, this mode does not provide atrioventricular synchronous pacing. We describe a case of a hybrid leadless system combining an atrial leadless pacemaker (Aveir AR, Abbott) and a second leadless pacemaker capable of atrial mechanical‐sensed ventricular pacing (Micra AV2, Medtronic) in the setting of extraction of an infected transvenous pacemaker, providing atrial pacing with ventricular backup capability while preserving atrial device longevity.
ABSTRACT Background Insertable cardiac monitors (ICMs) are increasingly used in pediatric patients, yet data on new‐generation devices remain limited. The aim of this retrospective study was to describe a single‐center real‐world experience with a new‐generation ICM in pediatric patients, focusing on procedural feasibility, sensing performance, transmission burden, and user experience. Methods Consecutive patients aged ≤18 years undergoing LUX‐Dx ICM implantation between 2023 and 2025 were included. Procedural characteristics, sensing parameters, transmission patterns, diagnostic yield, reprogramming strategies, and patient/caregiver‐reported experience were analyzed. Data are reported as median (25th–75th percentile) or mean ± standard deviation. Results Twenty‐nine patients underwent ICM implantation. Procedures were brief (6 ± 2 min) and complication‐free. Electrical parameters were satisfactory and stable at discharge. Follow‐up was 18 (6–23) months. A median of 2.7 transmissions per patient‐month were received, of which 55% were alerts. Time from arrhythmia detection to transmission was 15 (3–21) hours. The number of episodes per patient was 4.8 (3.1–15.9) per month, with substantial inter‐patient variability and bradycardia being the most frequent detection (80%). A diagnostic conclusion was reached in 79% of patients (positive: 45%, negative: 34%) at a median of 3 months. Reprogramming was performed in 90% of patients, mainly remotely (77%), and was predominantly directed toward reducing detection sensitivity. Patient and caregiver acceptance of remote monitoring was high. Conclusions In pediatric patients, new‐generation ICM implantation was safe, well tolerated, and associated with stable sensing performance. Remote monitoring and reprogramming enabled timely diagnosis and individualized optimization, supporting the clinical utility of contemporary ICMs in this population.
