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Faced with the escalating crisis of global deforestation, including particularly alarming rates in Sri Lanka, researchers have turned their attention to the potential of boronbased preservatives for treating timber. The comprehensive study of the samples has revealed a significant negative correlation between the treatability of timber under pressure and the total area of vessels and wood density. Woods with fewer and smaller vessels are more receptive to boron treatment, making them more suitable for preservation. The study also identified a positive, though somewhat weak, correlation between treatability and the total ray area within the wood, indicating that the internal structure of timber plays a crucial role in its preservation potential. The timber during the research has been categorized based on the depth of boron penetration, with categories ranging from fully penetrated to less than 5 mm. The findings obtained suggest that boron preservatives offer a promising and sustainable alternative to traditional timber treatment methods. By categorizing wood based on the treatability and anatomical properties, we can optimize the treatment processes, thereby maximizing resource utilization and minimizing waste. Thus boron-treated timber could become a cornerstone in the fight against deforestation in future, providing a responsible and environmentally friendly alternative to the untreated wood. In doing so, the research contributes significantly to the preservation of our forests and the overall well-being of our planet, offering a promising trajectory in sustainable forestry practices.

Abstract Cardiac resynchronisation therapy (CRT) improves prognosis in patients with heart failure (HF) however the role of ABO blood groups and Rhesus factor are poorly understood. We hypothesise that blood groups may influence clinical and survival outcomes in HF patients undergoing CRT. A total of 499 patients with HF who fulfilled the criteria for CRT implantation were included. Primary outcome of all-cause mortality and/or heart transplant/left ventricular assist device was assessed over a median follow-up of 4.6 years (IQR 2.3–7.5). Online repositories were searched to provide biological context to the identified associations. Patients were divided into blood (O, A, B, and AB) and Rhesus factor (Rh-positive and Rh-negative) groups. Mean patient age was 66.4 ± 12.8 years with a left ventricular ejection fraction of 29 ± 11%. There were no baseline differences in age, gender, and cardioprotective medication. In a Cox proportional hazard multivariate model, only Rh-negative blood group was associated with a significant survival benefit (HR 0.68 [0.47–0.98], p = 0.040). No association was observed for the ABO blood group (HR 0.97 [0.76–1.23], p = 0.778). No significant interaction was observed with prevention, disease aetiology, and presence of defibrillator. Rhesus-related genes were associated with erythrocyte and platelet function, and cholesterol and glycated haemoglobin levels. Four drugs under development targeting RHD were identified (Rozrolimupab, Roledumab, Atorolimumab, and Morolimumab). Rhesus blood type was associated with better survival in HF patients with CRT. Further research into Rhesus-associated pathways and related drugs, namely whether there is a cardiac signal, is required.

Implantable cardiac devices are a vital treatment option in the management of tachy/brady-arrhythmias and heart failure with conduction disease. In the recent years, these devices have become increasingly sophisticated, with high implantation success rates and longevity. However, these devices are not without risks and complications, which need to be carefully considered before implantation. In an era of rapidly evolving cardiac device therapies, this review article will provide an update on the literature and outline some of the emerging technologies that aim to maximise the efficiency of implantable devices and reduce complications. We discuss novel pacing techniques, including alternative pacing sites in anti-bradycardia and biventricular pacing, as well as the latest evidence surrounding leadless device technologies and patient selection for implantable device therapies.

Quantum computing is regarded as the future of computing that hopefully provides exponentially large processing power compared to the conventional digital computing. However, current quantum computers do not have the capability to correct errors caused by environmental noise, so that it is difficult to run useful algorithms that require deep quantum circuits. Therefore, emulation of quantum circuits in digital computers is essential. However, emulation of large quantum circuits requires enormous amount of computations, and leads to a very large processing time. To reduce the processing time, we propose an FPGA emulator with high-bandwidth-memory to emulate quantum Fourier transform (QFT), which is a major part of many quantum algorithms. The proposed FPGA emulator is scalable in terms of both processing speed and the number of qubits, and extendable to multiple FPGAs. We performed QFT emulations up to 30 qubits using two FPGAs. According to the measured results, we have achieved $23.6 \sim 24.5$ times speed-up compared to a fully optimized 24-core CPU emulator.

Background: Betel quid chewing is known as a crucial risk factor for oral diseases such as periodontal diseases, oral cancer, and precancerous lesions in Southeast Asian countries. Although abnormal oral bacterial flora may be linked to betel quid related-oral diseases such as oral cancer, precancerous lesions, and periodontal diseases, little information is available on alterations of their oral flora thus far. To identify these alterations, we analyzed the oral flora in betel quid chewers (BQC) and non-chewers (NC) in Sri Lanka. Methods: Samples obtained from buccal swabs of BQC and NC were analyzed with a next generation sequencer. Data were processed and analyzed using the QIIME software package. Mann–Whitney U test and Permutational multivariate analysis of variance were used for statistical analyses. P values

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Aims: The randomized, double‐blind, placebo‐controlled HOPE‐HF trial assessed the benefit of atrio‐ventricular (AV) delay optimization delivered using His bundle pacing. It recruited patients with left ventricular ejection fraction ≤40%, PR interval ≥200 ms, and baseline QRS ≤140 ms or right bundle branch block. Overall, there was no significant increase in peak oxygen uptake (VO2max) but there was significant improvement in heart failure specific quality of life. In this pre‐specified secondary analysis, we evaluated the impact of baseline PR interval, echocardiographic E‐A fusion, and the magnitude of acute high‐precision haemodynamic response to pacing, on outcomes. Methods and results: All 167 randomized participants underwent measurement of PR interval, acute haemodynamic response at optimized AV delay, and assessment of presence of E‐A fusion. We tested the impact of these baseline parameters using a Bayesian ordinal model on VO2max, quality of life and activity measures. There was strong evidence of a beneficial interaction between the baseline acute haemodynamic response and the blinded benefit of pacing for VO2 (Pr 99.9%), Minnesota Living With Heart Failure (MLWHF) (Pr 99.8%), MLWHF physical limitation score (Pr 98.9%), EQ‐5D visual analogue scale (Pr 99.6%), and exercise time (Pr 99.4%). The baseline PR interval and the presence of baseline E‐A fusion did not have this reliable ability to predict the clinical benefit of pacing over placebo across multiple endpoints. Conclusions: In the HOPE‐HF trial, the acute haemodynamic response to pacing reliably identified patients who obtained clinical benefit. Patients with a long PR interval (≥200 ms) and left ventricular impairment who obtained acute haemodynamic improvement with AV‐optimized His bundle pacing were likely to obtain clinical benefit, consistent across multiple endpoints. Importantly, this gradation can be reliably tested for before randomization, but does require high‐precision AV‐optimized haemodynamic assessment to be performed. [ABSTRACT FROM AUTHOR]

At present deforestation in Sri Lanka increases rapidly and therefore, extreme attention should be given to finding different alternatives to prevent the destruction of forests for timber. Treated timber is one of the best solutions for increasing the durability. Boron treatment and Copper Chrome Boron (CCB) treatment methods are usually used to treat timber in Sri Lanka. Those two treatment methods have some critical issues such as the leaching of chemicals and risk to both human beings and the environment. Therefore, Alkaline Copper Quaternary (ACQ) treatment which is used pressure impregnation method has been introduced to overcome those issues. It is important to build timber classifications according to their treatability and application method. Hence, the present study was carried out to identify the relationship between ACQ treatability with anatomical characteristics of timber and classify timber according to their treatability via pressure impregnation method at A Wood Lanka Company at Kottawa, Sri Lanka. For this study, mostly used fourteen local and six imported timber species were selected and each sample was 30cmx10cmx5.5cm in size. The solution strength of ACQ was 4% and the treatability of ACQ was measured using chemical retention which was measured by the weight difference before and after the treatment. Chemical penetration depth was observed by using Chrome Azurol S. According to the results, timber species were classified into four classes "very difficult to treat", "moderately difficult to treat", "easy to treat" and "very easy to treat". The most effective timber species for ACQ treatment was Rubber. The relationship between treatability and total ray area was positive while the relationship between treatability and total vessel area was negative. But both showed weak relationships. Timber species were also categorized into four classes "fully penetrated", "partially penetrated, "penetrated up to 5mm" and "low penetrated" according to their penetration depth. [ABSTRACT FROM AUTHOR]

Simulated quantum annealing (SQA) is a probabilistic approximation method to find a solution for a combinatorial optimization problem using digital computers. The processing time of SQA increases exponentially with the number of variables. Therefore, acceleration of SQA is regarded as a very important topic. However, parallel implementation is difficult due to the serial nature of the quantum Monte Carlo algorithm used in SQA. In this paper, we propose a method to implement SQA in parallel on a GPU while preserving the data dependency. According to the experimental results, we have achieved over 97 times speed-up while maintaining the same accuracy-level compared to a single-core CPU implementation.

Implantable cardiac devices are a vital treatment option in the management of tachy/brady-arrhythmias and heart failure with conduction disease. In the recent years, these devices have become increasingly sophisticated, with high implantation success rates and longevity. However, these devices are not without risks and complications, which need to be carefully considered before implantation. In an era of rapidly evolving cardiac device therapies, this review article will provide an update on the literature and outline some of the emerging technologies that aim to maximise the efficiency of implantable devices and reduce complications. We discuss novel pacing techniques, including alternative pacing sites in anti-bradycardia and biventricular pacing, as well as the latest evidence surrounding leadless device technologies and patient selection for implantable device therapies. [ABSTRACT FROM AUTHOR]

After the introduction of the OpenCL-based FPGA accelerator design method, FPGAs are getting very popular among high-performance computing. The key to achieving high performance using FPGAs is to design pipelined accelerators. We can increase the pipeline depth beyond the border of one FPGA by connecting multiple FPGAs using high-speed QSFP (quad small form-factor pluggable) connectors. Such a deeply-pipelined accelerator using multiple FPGAs works similar to a single very large FPGA. In this paper, we propose a multi-FPGA accelerator architecture for stencil computation by scaling in spacial and temporal dimensions. According to the experimental results, we achieved performance up to 950 GFLOP/s using one FPGA and nearly doubled the performance using two FPGAs. We achieved a high power-efficiency with competitive performances compared to high-end GPUs.

Wood anatomy is considered to be a precise and rapid method in wood identification. Eucalyptus is a diverse genus of trees in the family of Myrtaceae. Due to the lack of appropriate systematic approaches, timber identification of Eucalyptus species is presently done based on visual observations and personnel skills. Therefore, the authenticity of Eucalyptus species is frequently questioned at the timber market. Identification of Eucalyptus species based on anatomical properties is recognized to be an imperative exercise as it could minimize possible misleads in the timber industry. In this research, nine Eucalyptus species grown in Sri Lanka namely: E. camaldulensis, E. citriodora, E. torelliana, E. pilularis, E. tereticornis, E. globulus, E. microcorys, E. Robusta and E. grandis were employed in identifying the variation of wood anatomical features with the idea of distinguishing the species. Anatomical features published by International Association of Wood Anatomists (IAWA) were used as the reference. Twelve wood sections representing each species (Tangential and Transverse sections of the wood) were used to identify the microscopic features. Micrometrics SE Premium 4 software was used to analyze the anatomical features of the timber. Based on the anatomical features of rays, vessels and parenchyma, a Dichotomous key was developed for the precise identification of Eucalyptus species. [ABSTRACT FROM AUTHOR]

Background. Bone marrow necrosis (BMN) is a rare entity which presents with bone pain, fever, and peripheral cytopenia. Acute lymphoblastic leukaemia (ALL) is characterized by malignant proliferation of immature lymphocytes, and patients usually present with fatigue and bleeding manifestations. Presentation with BMN is an extremely rare finding and only few cases had been reported in the literature. Case Presentation. A 22-year-old male presented with nocturnal lower back ache, pleuritic central chest pain, and fever for two weeks. He was extensively investigated for a cause. His investigations revealed pancytopenia with severe neutropenia. Initial bone marrow aspiration and biopsy did not provide a positive result due to extensive necrosis. However, immunohistochemical analysis of few immature lymphoid cells on repeated BM biopsy showed evidence of acute lymphoblastic leukaemia. Conclusions. ALL usually presents with fatigue and bleeding manifestations. Presentation with BMN is extremely rare. The diagnosis was extremely challenging as this patient had only occasional atypical cells in the peripheral blood film and the repeat bone marrow (BM) biopsy showed extensive necrosis.

Off-cut wood is currently considered as waste thus is dumped by saw mills as they find no means of utilising them. Sawn timber material of furniture factories and short length of sawn timbers are also considered to be wastes in the timber industry. Finger jointing technique which interlock the end joints formed by machining a number of similar tapered symmetrical fingers are recognised in this regards as effective and sustainable means of utilisation of timber wastes. The present study was undertaken to assess the strength grade of finger jointed timber based on BS 5268-2:2002. Seven timber species which are commonly used in Sri Lanka were employed for the assessment with and without finger joints. Values of Modulus of Rupture (MOR), Modulus of Elasticity (MOE), Compression parallel to grain and Compression perpendicular to grain strength of the specimens were measured. Finger jointing was performed with constant geometry (finger length 19 mm, tip width 1 mm and finger pitch 4 mm) using polyvinyl acetate (PVA, P-SWR) adhesive at normal exposure conditions. The strength properties were evaluated by Universal Testing Machine (UTM) according to BS 373:1957. Strength classes relevant to the grade stresses were not significant for finger jointed and clear specimens of Satin, Mahogany, Jack and Grandis. Both clear and finger jointed timber specimens obtained D40 for Satin and Teak, D30 for Jack, Mahogany and Grandis. Teak shows properties similar to both D35 and D40 when used as finger jointed timber. Kumbuk was shown to change from D40 to D30 while using as finger jointed timber. Finger jointed Pine showed stress grade of C22, C24 and C27.

Aims Left bundle branch pacing (LBBP) can deliver physiological left ventricular activation, but typically at the cost of delayed right ventricular (RV) activation. Right ventricular activation can be advanced through anodal capture, but there is uncertainty regarding the mechanism by which this is achieved, and it is not known whether this produces haemodynamic benefit. Methods and results We recruited patients with LBBP leads in whom anodal capture eliminated the terminal R -wave in lead V1. Ventricular activation pattern, timing, and high-precision acute haemodynamic response were studied during LBBP with and without anodal capture. We recruited 21 patients with a mean age of 67 years, of whom 14 were males. We measured electrocardiogram timings and haemodynamics in all patients, and in 16, we also performed non-invasive mapping. Ventricular epicardial propagation maps demonstrated that RV septal myocardial capture, rather than right bundle capture, was the mechanism for earlier RV activation. With anodal capture, QRS duration and total ventricular activation times were shorter (116 ± 12 vs. 129 ± 14 ms, P < 0.01 and 83 ± 18 vs. 90 ± 15 ms, P = 0.01). This required higher outputs (3.6 ± 1.9 vs. 0.6 ± 0.2 V, P < 0.01) but without additional haemodynamic benefit (mean difference −0.2 ± 3.8 mmHg compared with pacing without anodal capture, P = 0.2). Conclusion Left bundle branch pacing with anodal capture advances RV activation by stimulating the RV septal myocardium. However, this requires higher outputs and does not improve acute haemodynamics. Aiming for anodal capture may therefore not be necessary. [ABSTRACT FROM AUTHOR]

Background: The use of left bundle branch area pacing (LBBAP) for bradycardia pacing and cardiac resynchronization is increasing, but implants are not always successful. We prospectively studied consecutive patients to determine whether septal scar contributes to implant failure. Methods: Patients scheduled for bradycardia pacing or cardiac resynchronization therapy were prospectively enrolled. Recruited patients underwent preprocedural scar assessment by cardiac MRI with late gadolinium enhancement imaging. LBBAP was attempted using a lumenless lead (Medtronic 3830) via a transeptal approach. Results: Thirty‐five patients were recruited: 29 male, mean age 68 years, 10 ischemic, and 16 non‐ischemic cardiomyopathy. Pacing indication was bradycardia in 26% and cardiac resynchronization in 74%. The lead was successfully deployed to the left ventricular septum in 30/35 (86%) and unsuccessful in the remaining 5/35 (14%). Septal late gadolinium enhancement was significantly less extensive in patients where left septal lead deployment was successful, compared those where it was unsuccessful (median 8%, IQR 2%–18% vs. median 54%, IQR 53%–57%, p <.001). Conclusions: The presence of septal scar appears to make it more challenging to deploy a lead to the left ventricular septum via the transeptal route. Additional implant tools or alternative approaches may be required in patients with extensive septal scar. [ABSTRACT FROM AUTHOR]

Finite difference time domain (FDTD) method is a very poplar way of numerically solving partial differential equations. FDTD has a low operational intensity so that the performances in CPUs and GPUs are often restricted by the memory bandwidth. Recently, deeply pipelined FPGA accelerators have shown a lot of success by exploiting streaming data flows in FDTD computation. In spite of this success, many FPGA accelerators are not suitable for real-world applications that contain complex boundary conditions. Boundary conditions break the regularity of the data flow, so that the performances are significantly reduced. This paper proposes an FPGA accelerator that computes commonly used absorbing and periodic boundary conditions in many 3D FDTD applications. Accelerator is designed using a “C-like” programming language called OpenCL (open computing language). As a result, the proposed accelerator can be customized easily by changing the software code. According to the experimental results, we achieved over 3.3 times and 1.5 times higher processing speed compared to the CPUs and GPUs, respectively. Moreover, the proposed accelerator is more than 14 times faster compared to the recently proposed FPGA accelerators that are capable of handling complex boundary conditions.

This paper presents a new chaos-based image cipher using a plaintext-related permutation. The cat map and Lorenz system are employed to shuffle the positions of image pixels and generate the diffusion keystream, respectively. The control parameters of the cat map, i.e. the permutation key, are determined by the Murmur2 hash value of the original image. Owing to the avalanche property of hash functions, completely different shuffled images will be produced even if there is a tiny difference between the original ones, and it helps accelerate the diffusion process. Experimental results indicate that the proposed scheme requires only one and two cipher cycles to achieve an acceptable and a satisfactory diffusion properties, respectively, whereas two and three cipher cycles are needed by typical schemes to achieve the same properties. Thorough security analysis is carried out, and the results demonstrate the satisfactory security of the proposed scheme.

Aims Left bundle branch area pacing (LBBAP) is a promising method for delivering cardiac resynchronization therapy (CRT), but its relative physiological effectiveness compared with His bundle pacing (HBP) is unknown. We conducted a within-patient comparison of HBP, LBBAP, and biventricular pacing (BVP). Methods and results Patients referred for CRT were recruited. We assessed electrical response using non-invasive mapping, and acute haemodynamic response using a high-precision haemodynamic protocol. Nineteen patients were recruited: 14 male, mean LVEF of 30%. Twelve had time for BVP measurements. All three modalities reduced total ventricular activation time (TVAT), (ΔTVATHBP -43 ± 14 ms and ΔTVATLBBAP −35 ± 20 ms vs. ΔTVATBVP −19 ± 30 ms, P = 0.03 and P = 0.1, respectively). HBP produced a significantly greater reduction in TVAT compared with LBBAP in all 19 patients (−46 ± 15 ms, −36 ± 17 ms, P = 0.03). His bundle pacing and LBBAP reduced left ventricular activation time (LVAT) more than BVP (ΔLVATHBP −43 ± 16 ms, P < 0.01 vs. BVP, ΔLVATLBBAP −45 ± 17 ms, P < 0.01 vs. BVP, ΔLVATBVP −13 ± 36 ms), with no difference between HBP and LBBAP (P = 0.65). Acute systolic blood pressure was increased by all three modalities. In the 12 with BVP, greater improvement was seen with HBP and LBBAP (6.4 ± 3.8 mmHg BVP, 8.1 ± 3.8 mmHg HBP, P = 0.02 vs. BVP and 8.4 ± 8.2 mmHg for LBBAP, P = 0.3 vs. BVP), with no difference between HBP and LBBAP (P = 0.8). Conclusion HBP delivered better ventricular resynchronization than LBBAP because right ventricular activation was slower during LBBAP. But LBBAP was not inferior to HBP with respect to LV electrical resynchronization and acute haemodynamic response. [ABSTRACT FROM AUTHOR]

Aims: Excessive prolongation of PR interval impairs coupling of AV contraction, which reduces left ventricular pre-load and stroke volume, and worsens symptoms. His-bundle pacing allows AV-delay shortening while maintaining normal ventricular activation. HOPE-HF evaluated whether AV-optimized His pacing is preferable to no-pacing, in double-blind cross-over fashion, in patients with heart failure, left ventricular ejection fraction (LVEF) ≤40%, PR interval ≥200ms and either QRS ≤140ms or right BBB.Methods and Results: Patients had atrial and His-bundle leads implanted (and an ICD lead if clinically indicated) and were randomized, to 6-months of pacing and 6-months of no-pacing utilizing a cross-over design. The primary outcome was peak oxygen uptake during symptom-limited exercise. Quality of life, LVEF and patients' holistic symptomatic preference between arms were secondary outcomes. 167 patients were randomized: 90% men, 69±10 years, QRS duration 124±26ms, PR interval 249±59ms, LVEF 33±9%. Neither peak VO2 (+0.25 ml/min/kg, 95% CI -0.23 to +0.73, p=0.3) nor LVEF (+0.5%, 95% CI -0.7 to 1.6, p=0.4) changed with pacing but Minnesota Living with Heart Failure quality of life improved significantly (-3.7, 95% CI -7.1 to -0.3, p=0.03). 76% of patients preferred His-bundle pacing-on and 24% pacing-off (p<0.0001).Conclusion: His-bundle pacing did not increase peak oxygen uptake but, under double-blind conditions, significantly improved quality of life and was symptomatically preferred by the clear majority of patients. Ventricular pacing delivered via the His bundle did not adversely impact ventricular function during the 6 months. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

Aims Cardiac resynchronization therapy programmed to dynamically fuse pacing with intrinsic conduction using atrioventricular (AV) timing algorithms (e.g. SyncAV) has shown promise; however, mechanistic data are lacking. This study assessed the impact of SyncAV on electrical dyssynchrony across various pacing modalities using non-invasive epicardial electrocardiographic imaging (ECGi). Methods and results Twenty-five patients with left bundle-branch block (median QRS duration (QRSd) 162.7 ms) and intact AV conduction (PR interval 174.0 ms) were prospectively enrolled. ECGi was performed acutely during biventricular pacing with fixed nominal AV delays (BiV) and using SyncAV (optimized for the narrowest QRSd) during: BiV + SyncAV, LV-only single-site (LVSS + SyncAV), MultiPoint pacing (MPP + SyncAV), and LV-only MPP (LVMPP + SyncAV). Dyssynchrony was quantified via ECGi (LV activation time, LVAT; RV activation time, RVAT; LV electrical dispersion index, LVEDi; ventricular electrical uncoupling index, VEU; and biventricular total activation time, VVtat). Intrinsic conduction LVAT (124 ms) was significantly reduced by BiV pacing (109 ms) (P = 0.001) and further reduced by LVSS + SyncAV (103 ms), BiV + SyncAV (103 ms), LVMPP + SyncAV (95 ms), and MPP + SyncAV (90 ms). Intrinsic RVAT (93 ms), VVtat (130 ms), LVEDi (36 ms), VEU (50 ms), and QRSd (163 ms) were reduced by SyncAV across all pacing modes. More patients exhibited minimal LVAT, VVtat, LVEDi, and QRSd with MPP + SyncAV than any other modality. Conclusion Dynamic AV delay programming targeting fusion with intrinsic conduction significantly reduced dyssynchrony, as quantified by ECGi and QRSd for all evaluated pacing modes. MPP + SyncAV achieved the greatest synchrony overall but not for all patients, highlighting the value of pacing mode individualization during fusion optimization. [ABSTRACT FROM AUTHOR]

Shorter sections of sawn timber material resulted from timber industry are considered to be wastes; thus regularly dumped by sawmills. Finger-joint, a method which connects two small pieces of timber together is recognized as a sound technique to minimize the wastage. In this process, sections of different timber species are bonded together for making finger-joint boards. In this connection, selection of the best possible combination of timber species is vital as the success largely depends on the mechanical properties of the pieces. In this study, commonly used 32 timber species were employed to develop a timber classification system based on strength properties of timber species. Cluster analysis was used in grouping the species with similar strength properties. Accordingly, timber species were grouped into five strength classes as very low, low, medium, high and very high. A significant correlation (P = 0.000) between the strength index and timber density was also observed. [ABSTRACT FROM AUTHOR]

Aims: To determine the incidence, clinical features, management, and outcomes of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) lead cardiac perforation. Cardiac perforations due to PM and ICD leads are rare but serious complications. Clinical features vary widely and may cause diagnostic delay. Management strategies are non-guideline based due to paucity of data.Methods and Results: A multicentre retrospective series including 3 UK cardiac tertiary centres from 2016 to 2020. Patient, device, and lead characteristics were obtained including 6-month outcomes. Seventy cases of perforation were identified from 10 631 procedures; perforation rate was 0.50% for local implants. Thirty-nine (56%) patients were female, mean ( ± standard deviation) age 74 ( ± 13.8) years. Left ventricular ejection fraction 51 ( ± 13.2) %. Median time to diagnosis was 9 (range: 0-989) days. Computed tomography (CT) diagnosed perforation with 97% sensitivity. Lead parameter abnormalities were present in 86% (whole cohort) and 98.6% for perforations diagnosed >24 h. Chest pain was the commonest symptom, present in 46%. The management strategy was percutaneous in 98.6% with complete procedural success in 98.6%. Pericardial effusion with tamponade was present in 17% and was associated with significantly increased mortality and major complications. Anticoagulation status was associated with tamponade by multivariate analysis (odds ratio 21.7, 95% confidence interval: 1.7-275.5, P = 0.018).Conclusions: Perforation was rare (0.50%) and managed successfully by a percutaneous strategy with good outcomes. Tamponade was associated with increased mortality and major complications. Anticoagulation status was an independent predictor of tamponade. Case complexity is highly variable and requires skilled operators with a multi-disciplinary approach to achieve good outcomes. [ABSTRACT FROM AUTHOR]