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.
ABSTRACT Atrioventricular conduction disturbances and the need for cardiac implantable electronic device (CIED) therapy are frequently required after transcatheter tricuspid valve implantation (TTVI). The interaction between the annulus, transcatheter heart valve and the leads is often complex and the optimal management under debate. We prospectively included 36 patients undergoing TTVI between June 2021 and January 2025. 14 patients had a preexisting CIED. 11 patients experienced right ventricular lead‐jailing without signs for early or delayed lead failure after one year, one patient underwent lead extraction and two patients had a leadless pacemaker. In four patients, a pacemaker in LBBAP was successfully implanted due to new‐onset postoperative atrioventricular block. The device measurements as well as the valve function remained stable over a follow‐up of at least one up to 2.5 years with persistent LBB‐capture. This case series demonstrates that LBBAP following TTVI is feasible with encouraging early outcomes. Careful patient selection and dedicated follow‐up are essential for patients with CIED treated with TTVI.
Background Optimization of biventricular pacing for cardiac resynchronization therapy (CRT) with fusion (fusion-optimized intervals method) has been shown to improve left ventricular remodeling. However, information on programming the atrioventricular (AV) interval during left bundle branch pacing (LBBP) is scarce.Objective Assess with electrocardiographic imaging (ECGI) the electrical benefit of optimization of the AV interval during LBBP.Methods Retrospective analysis of prospectively collected data. Pilot study including patients who received LBBP with CRT indication, normal AV conduction, sinus rhythm, and left bundle branch block. ECGI was used to obtain non-invasive activation maps, ventricular activation times, and QRS widths during the optimization of the AV interval.Results A total of 10 patients who received LBBP were included. Median age was 62 years (57-74 years), 40% were women, 20% had ischemic cardiomyopathy, and baseline LVEF was 29% (23%-36%). The baseline median QRS duration was 178 ms (168-187 ms), with a left ventricular activation time (LVAT) of 99 ms (90-109 ms), a right ventricular activation time (RVAT) of 42 ms (34-71 ms), and a total ventricular activation time (TAT) of 111 ms (105-131 ms).A non-tailored AV programming showed a QRS measured from intrinsic deflection of 142 ms (137-149 ms); when a tailored AV was programmed, the median QRS decreased to 124 ms (116-130 ms). Ventricular activation times showed shortening with a tailored approach.Conclusion AV interval adjustment during left bundle branch pacing may result in better resynchronization.
Background Permanent pacing after tricuspid transcatheter edge-to-edge repair (TEER) may be technically challenging due to the risk of interaction between pacing systems and repair devices. Evidence guiding optimal pacing strategies in this setting remains limited.Methods We report a single-center case series of three patients with previous tricuspid TEER who required permanent pacing. Device selection and procedural planning were guided by multimodality imaging, including transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE). Valve-sparing pacing strategies were selected according to individual clinical characteristics.Results Two elderly patients underwent implantation of a leadless pacemaker, while a third patient with dilated cardiomyopathy underwent left bundle branch area pacing (LBBAP) during cardiac resynchronization therapy upgrade. Imaging guidance allowed safe traversal of the repaired tricuspid valve while avoiding mechanical interaction with the TEER devices. All procedures were successful, with stable pacing parameters and no procedural complications. Tricuspid regurgitation remained unchanged in all patients during follow-up. In the patient undergoing LBBAP, left ventricular ejection fraction improved from 30% to 57% at 6 months.Conclusions Valve-sparing pacing strategies guided by multimodality imaging appear feasible and safe in patients with prior tricuspid TEER. Leadless pacemakers and conduction system pacing represent complementary options that can be tailored to individual clinical profiles.
