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Background: Fontan surgery, a palliative procedure for single ventricle patients, often leads to the need for permanent pacing. Epicardial pacing has limitations, while transvenous pacing carries risks in the Fontan circulation. This case series introduces a novel approach of leadless pacemaker implantation in the extra‐cardiac Fontan (ECF) cohort to overcome these limitations. Methods: The study includes four cases of leadless pacemaker (Micra™) implantation in patients with ECF. Procedures were performed under general anesthesia with guidance from trans‐esophageal echocardiography. Various access routes were used, including trans‐carotid and trans‐fenestration approaches. Procedural details, parameters, and follow‐up data were collected. Results: All leadless pacemaker implantations were successful, with satisfactory electrical parameters and stable pacing postprocedural outcomes during short‐term follow‐up. One patient required closure of their fenestration for symptomatic desaturation post procedurally. Conclusions: Leadless pacemaker implantation via trans‐carotid and trans‐fenestration approaches appears to be a feasible back up option for pacing in Fontan patients where other options have been exhausted or there is a patient choice to avoid surgery. These techniques provide an option to avoid leaded systems or epicardial pacing, reducing the need for multiple thoracotomies and addressing challenges associated with surgical pacing leads. Further studies are needed to evaluate long‐term outcomes and assess the broader application of leadless pacemakers in the Fontan population. [ABSTRACT FROM AUTHOR]

Purpose: As part of the European risk management plan of a 91‐day extended levonorgestrel‐containing combined oral contraceptive (COCLNG), a study was performed to assess its safety. This analysis was conducted to examine delayed pregnancy detection and return to fertility with extended combined oral contraceptives (COC). Methods: We conducted a retrospective cohort study in new users of 91‐day COCLNG or 28‐day COCLNG within a US‐based healthcare claims database from 2006 to 2017. Delayed pregnancy detection during current COCLNG exposure was defined as the time between estimated pregnancy start and first prenatal care encounter. Additionally, the time between estimated pregnancy start and COCLNG discontinuation was measured. To measure return to fertility, pregnancy rates were estimated among females who discontinued treatment. 91‐day COCLNG users were propensity score‐matched to 28‐day COCLNG users. Hazard ratio for pregnancy was calculated using Cox proportional hazards models. Results: The 91‐day and 28‐day COCLNG users had 25 593 and 76 586 treatment episodes, respectively. The median time to pregnancy detection was 64.5 and 61.0 days (p = 0.24) in users of 91‐day COCLNG and 28‐day COCLNG. The median exposure time to treatment after estimated pregnancy start was 54.0 and 38.0 days (p < 0.01). In the fertility analysis, pregnancy rates were 54.82 (95% CI, 50.05–59.93) and 69.30 (95% CI, 64.98–73.82) per 1000 person‐years in extended COCLNG discontinuers and 28‐day COCLNG discontinuers. The adjusted hazard ratio of pregnancy was 0.77 (95% CI, 0.69–0.85). Conclusions: Small differences were observed for pregnancy rates and delayed pregnancy detection between 91‐day extended COCLNG and 28‐day COCLNG, which may be related to the longer days' supply of extended COCLNG. Differences in the fertility analysis may be related to unmeasured residual confounding. [ABSTRACT FROM AUTHOR]

(2957) Proposal to conserve the name Dryopteris affinis (Lowe) Fraser-Jenk. against D. affinis Kinahan (Pteridophyta: Dryopteridaceae) This earlier I D. affinis i Kinahan, although also illegitimate, being necessarily typified by the type of I D. caucasica i , the legitimate replacement name for I Aspidium affine i Fisch. Accordingly it is proposed here to conserve the name I Dryopteris affinis i (Lowe) Fraser-Jenk. against I D. affinis i Kinahan to maintain nomenclatural stability for the species concerned. [Extracted from the article]