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Background: Conventional right ventricle (RV) pacemaker stimulation has been associated with worse clinical outcomes in patients with cardiac amyloidosis (CA). Left bundle branch area pacing (LABPP) has been suggested as a promising alternative. We sought to assess the safety, feasibility, and outcomes of LABPP in patients with CA. Methods: We retrospectively analyzed echocardiography and pacing parameters and clinical outcomes in 23 consecutive patients with CA and LBBAP implanted from June 2020 to October 2022. Results: LBBAP was successfully performed in 22 over 23 patients (19 male, 78.6 ± 11.7 years, 20 ATTR, mean LVEF 45.5 ± 16.2%). After the procedure, 9 patients showed Qr pattern and 11 a qR pattern in V1 on ECG. Average procedure time was 67 ± 28 min. After 7.7 ± 5.2 months follow‐up, no procedure‐related complications had occurred. Although, a significant reduction in QRS width (p =.001) was achieved, we did not observe significant changes in LVEF and Nt ProBNP at 6 months of follow‐up. Pacing parameters were stable during follow‐up: LBB capture threshold and R wave amplitude were 1.0 ± 0.5 V and 10.6 ± 6.0 mV versus 0.8 ± 0.1 V, p =.21 and 10.6 ± 5.1 mV (p =.985) at follow up. Conclusion: LBBAP is safe and feasible pacing technique for patients with CA. LBBAP is associated with significant narrowing of QRSd without worsening in LVEF and Nt‐proBNP. [ABSTRACT FROM AUTHOR]

Background: Left bundle branch pacing (LBBP) may be achieved in various anatomical sites within the interventricular septum (IVS), thus influencing paced QRS duration (QRSd).The purpose of this study was to determine whether paced QRS axis (QRSâ) and predominant polarity in inferior leads could be associated with a shorter paced QRSd. Methods: We analyzed paced QRSd, QRSâ, polarity in inferior leads, and IVS thickness in patients referred for LBBP. Three paced morphology patterns in the inferior leads were considered: All positive (P), all negative (N) and intermediate (combination of isoelectric, positive, and negative complexes, (I). Patients were divided into two groups according to a paced QRSd < 120 or ≥ 120 ms. Results: A total of 125 patients were included (age 76 ± 10 years, 46% female). Mean baseline QRSâ was 8 ± 37°. Paced QRSd was significantly shorter as compared to baseline (120 ± 10 vs. 127 ± 33 ms; p =.017) and significantly different according to paced QRS morphology pattern in the inferior leads (P 49%, 119 ± 9; N 30%, 126 ± 12; I 21%; 113 ± 10 ms; p <.001) or paced QRSâ (Normal 59%, 116 ± 1; Right 6%, 129 ± 1; Left 35%, 124 ± 11 ms; p <.001). On multivariate analysis, a QRSâ > −30°(OR 5.79 [2.40–13.93; 95% CI] p =.001), an Intermediate pattern in inferior leads (OR 3.00 [1.67–8.43; 95% CI] p =.037), and an IVS thickness ≤ 10 mm (OR 2.59 [1.10–6.10; 95% CI]; p =.029) were significantly associated with a paced QRSd < 120 ms. Conclusions: During LBBP, a QRSâ > −30° and intermediate final polarity in inferior leads are associated with a shorter paced QRSd. [ABSTRACT FROM AUTHOR]

Background: Embolic cerebrovascular events that remain of unknown etiology after a thorough diagnostic evaluation, are known as Embolic Strokes of Undetermined Source (ESUS). Subclinical atrial fibrillation (AF) represents a significant underlying cause of ESUS. Our aims were to examine the overall diagnostic yield of a prolonged cardiac monitoring wearable system (PCMw) after an ESUS to detect AF and factors associated with it, including the time frame from the ESUS event to PCMw initiation. Additionally, to evaluate the frequency of unexpected arrhythmic events (UAE) and their prognostic implications. Methods: We retrospectively analyzed 200 ECG recordings (3‐leads, 30 days duration) by means of a PCMw in patients with an ESUS to detect AF lasting longer than 30 s, between 2017 and 2021. UAE were defined as arrhythmia events that were not correlated to the main reason of prolonged cardiac monitoring. Results: AF was detected in 21 patients (10.5%). Patients with AF had more left atrial enlargement (OR = 4.22 [1.59–6.85]; p =.01) and atrial arrythmias in the initial 24‐h Holter during hospitalization (OR = 5.73 [2.03–16.49]; p =.001). The detection of AF was significatively higher if the PCMw was worn within the first 30 days after the ESUS compared to beyond 30 days (17% vs. 10.3%; p =.002). Fifty three patients (26.5%) had UAE during PCMw. In six of them these findings led to targeted treatment. Conclusion: PCMw represents a feasible non‐invasive device that could reliably detect subclinical AF episodes after an ESUS. Diagnostic yield was significatively higher when used within the first 30 days after the event, especially in selected patients. UAE were common, but did not impact prognosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: The common practice after atrial fibrillation ablation is to admit patients for an overnight stay. The aim of this study was to compare a strategy of vascular suture mediated closure system utilization and early discharge (strategy A) compared to traditional closure and overnight hospitalization (strategy B) regarding feasibility, safety, quality of life and health care cost effectiveness. Methods and Results: Hundred patients were randomized to compare both strategies. No clinical differences were reported except diabetes mellitus. Six patients (6%) had and emergency visit or were admitted in the first 30 days after procedure. Three occurred in strategy A versus three in strategy B (p = 1) (p <.005 for non‐inferiority). Forty out of 50 patients (80%) were safely discharged in a time frame of 3 h and 42 patients (84%) were discharged in the same day of the procedure in strategy A. Time to discharge was shorter in strategy A compared to strategy B. (5.89 ± 7.47 h vs. 27.09 ± 2.29 p <.005). No differences were obtained in quality‐of‐life outcomes. Mean (95% CI) euros cost saving per patient in strategy A was 379.16 ± 93.55 p <.001. Ten acute complications (10% patients CI 95% 4.02%–15.98%) were reported during the trial. Seven (14% CI 95% 4.04%–23.96%) occurred in strategy A patients versus 3 (6% CI 95% 0.8%–12.8%) in strategy B. (p =.182) Conclusion: A strategy of vascular suture mediated closure system utilization and early discharge was feasible, reduced time to discharge, saved costs and was not associated with more complications or admissions/emergency visits in a 30‐day time frame after procedure compared to a strategy of regular admission and discharge after overnight stay. There were no differences regarding quality‐of‐life parameters between both strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Superior vena cava (SVC) has been considered a specific trigger in atrial fibrillation development. METHODS: We investigated the efficacy and safety of combining cryoballoon pulmonary vein isolation (PVI) with SVC ablation compared with PVI alone in 100 patients with paroxysmal or non–long-standing persistent atrial fibrillation. Patients were randomly assigned to either the PVI+SVC ablation group or the PVI-only group. Each patient was given a mobile device to record a daily ECG and detect atrial tachyarrhythmias. RESULTS: The primary end point, freedom from any atrial tachyarrhythmia recurrence between 91 and 365 days post-catheter ablation, did not significantly differ between the 2 groups (62.9% versus 72%; P =0.41). However, the PVI+SVC group exhibited higher rates of phrenic nerve paralysis (20.8% versus 6%; P =0.003) and transient sinus node injury (18.8% versus 0%; P =0.001) compared with the PVI-only group. The median burden of atrial tachyarrhythmia showed no significant difference (P =0.91). CONCLUSIONS: The addition of SVC ablation to PVI did not enhance freedom from atrial tachyarrhythmia at 12 months, and it led to increased complications. These findings do not support the routine inclusion of SVC ablation in cryoballoon procedures for first-time catheter ablation in patients with paroxysmal or non–long-standing persistent atrial fibrillation. [ABSTRACT FROM AUTHOR]

We present the case of a 75‐year‐old woman with severe aortic stenosis and moderate left ventricular dysfunction, who underwent elective transcatheter aortic valve replacement. After the procedure, the patient developed a left bundle branch block and a long PR interval. For this reason, a dual chamber pacemaker with pacing in the left bundle branch area was implanted. On device interrogation, we confirmed the presence of functional atrial undersensing causing loss of ventricular electric resynchronization. This case highlights the importance of recognizing this problem and, by means of device reprogramming and pharmacological intervention, suggests a stepwise approach to solve it. [ABSTRACT FROM AUTHOR]

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Background: Wild-type transthyretin amyloidosis is a systemic disease with predominantly cardiac symptoms. The aim of this study was to assess the short-term prognosis of these patients through contractile reserve measured by stress echocardiography, given the usefulness that this parameter has demonstrated in other populations. We considered major events as death from any cause and hospitalization for heart failure. Material and methods: We conducted a study with a 1-year follow-up in 11 patients who were proposed to undergo a stress echocardiogram, with the follow-up as usual according to their doctor. We excluded pacemaker wearers, patients with permanent atrial fibrillation, those incapable of exertion at low loads, and those with poor acoustic windows. Results: We found that contractile reserve estimated by right ventricular free wall longitudinal strain is correlated with a lower rate of death (all of them cardiovascular deaths) and hospitalizations for heart failure. Conclusions: Contractile reserve assessed by right ventricular free wall longitudinal strain is a predictor of major events in patients with wild-type transthyretin cardiac amyloidosis. [ABSTRACT FROM AUTHOR]