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Aims: Left bundle branch area pacing (LBBaP) upgrade can improve cardiac function and clinical outcomes in patients with pacing‐induced cardiomyopathy (PICM), but the specific value of LBBaP upgrade, especially compared with the cardiac function level before right ventricular pacing (RVP) in patients with PICM and non‐pacing‐induced cardiomyopathy‐related upgrade status (Non‐PICMUS) is still unknown. Methods: This study retrospectively enrolled 70 patients with LBBaP upgrade (38 patients with PICM and 32 patients with Non‐PICMUS). All upgrade patients experienced three stages: before RVP (Pre‐RVP), before LBBaP upgrade (Pre‐LBBaP), and after LBBaP upgrade (Post‐LBBaP). QRS duration (QRSd), lead parameters, echocardiographic indicators, and clinical outcomes evaluation were recorded at multiple time points. Results: At the follow‐up of 12 months, for PICM patients, left ventricular ejection fraction (LVEF) significantly increased from 36.6% ± 7.2% to 51.3% ± 8.7% Post‐LBBaP (p <.001), and left ventricular end‐diastolic diameter (LVEDD) significantly decreased from 61.5 ± 6.4 mm to 55.2 ± 6.5 mm Post‐LBBaP (p <.001), but they both failed to restore the level Pre‐RVP (both p <.001). For PICM patients, New York Heart Association (NYHA) classification, the number of moderate‐to‐severe heart failure (NYHA III–IV), and diuretics using rate after the LBBaP upgrade also could not restore to the level Pre‐RVP (all p <.001). At the follow‐up of 12 months, Non‐PICMUS patients after the LBBaP upgrade had no significant improvement in LVEF, LVEDD, and NYHA classification (all p >.05). Conclusion: LBBaP upgrade effectively improved the cardiac function and clinical outcomes in PICM patients, but its effectiveness seemed to be limited as the deteriorated cardiac function cannot be completely reversed. For Non‐PICMUS patients, the cardiac function and clinical outcomes Post‐LBBaP had no significant improvement. [ABSTRACT FROM AUTHOR]

Background: Intracardiac echocardiography (ICE) technology has been increasingly accepted as an integral part of atrial fibrillation (AF) ablation procedures. It is still unknown whether ICE can routinely replace transesophageal echocardiography (TEE) for routine thrombus screening in non‐selective AF patients. Objective: To assess whether ICE can routinely replace TEE in screening for left atrial (LA)/left atrial appendage (LAA) thrombus in general patients undergoing catheter ablation for AF. Methods: A total of 2003 consecutive patients undergoing AF ablation were included. 1155 patients (ICE group) received intra‐procedural ICE examination for LA/LAA thrombus screening, while 848 patients (TEE group) received pre‐procedure TEE examination. The incidence of thrombus, peri‐procedure complications, and hospital efficiency were assessed. Results: The LA and LAA were adequately visualized in all patients. Five patients in the ICE group and 15 patients in the TEE group were found to have LAA thrombus. The incidence of major periprocedural thrombo‐embolic events was comparable between two groups (0.2% vs. 0.1%, p =.76), none were due to undetected LA/LAA thrombus. Other major periprocedural complications occurred at similar rates in both groups, while post‐procedure fever was less common in the ICE group (12.7% vs. 17.4%, p <.001). Procedure times and hospital length of stay were both shorter in the ICE group (142 min [87–197 min] vs. 150 min [95–205 min], and 3[2–4] day vs. 4[3–5] day, respectively, both p <.001). Conclusions: ICE can replace TEE for atrial thrombus screening in AF patients undergoing ablation without increased complications. An "ICE replacing TEE" workflow can also reduce the incidence of postoperative fever and improve hospital efficiency. [ABSTRACT FROM AUTHOR]

Background: Left bundle branch area pacing (LBBAP) aims to capture the cardiac conduction system in area of the left bundle branch. Currently, LBBAP is mainly performed using lumen‐less pacing leads (LLLs) with preshaped sheath. However, the data on LBBAP with stylet‐driven leads (SDLs) without sheath is limited. Objective: This study presents the feasibility, safety, and pacing characteristics of LBBAP using SDLs without the support of sheath. Methods: A total of 25 patients with bradycardia indications who received LBBAP implantation with an attempt of SDL (FINELINE II 4471 lead, Boston Scientific, MA, US) between August 2020 and April 2021 at Sir Run Run Shaw Hospital were included in this retrospective cohort study. Twenty of them finally were paced with SDL in priority (SDL‐LBBAP group). Twenty propensity score matching patients who underwent LBBAP with LLL (Select Secure 3830 lead, Medtronic, MN, US) and 20 right ventricular septal pacing (RVSP) with regular active fixation lead respectively in the same period (the LLL‐LBBAP group and RVSP group) were compared using ECG characteristics, pacing parameters and complications during 6‐month follow‐up. Results: LBBAP was successful with SDL in 23 of 25 patients (92%) and 20 of them were paced with SDL first. In the SDL‐LBBAP group, the average age was 70.4 ± 8.2 years, and 55% of patients were male. Paced QRS duration and the stimulus to peak left ventricular activation time (Sti‐LVAT) in SDL‐LBBAP group were similar with those in LLL‐LBBAP group and significantly shorter than those in RVSP group (126.1±14.1 ms vs. 124.8±10.9 ms, p = 1.00; 77.7 ± 11.2 ms vs. 73.5 ± 9.3 ms, P =.75; 126.1 ± 14.1 ms vs. 147.7 ± 22.5 ms, P<.001; 77.7 ± 11.2 ms vs. 97.0 ± 13.2 ms, P<.001). The pacing threshold and R‐wave amplitude of SDL‐LBBAP group were 0.53 ± 0.18V and 11.53 ± 3.63 mV at baseline respectively, which were comparable with the other two groups. During the 6‐month follow‐up, the pacing parameters remained stable and no lead‐related complications were recorded. Conclusion: It is feasible and safe to use stylet‐directed pacing lead for permanent LBBAP without a delivery sheath. Similar to LLL, LBBAP using SDL showed stable parameters and narrower paced QRS duration compared with RVSP, which could be an alternative to LLL in LBBAP. [ABSTRACT FROM AUTHOR]

Background: Tachycardia‐induced cardiomyopathy is poorly recognized pre‐ablation. It remains unclear of better patient selection and timing for catheter ablation in persistent atrial fibrillation (PerAF) with heart failure (HF). Methods: Consecutive patients with PerAF and left ventricular ejection fraction (LVEF) <50% referred for AF ablation were retrospectively included. The impact of LV size, heart rate (HR), and LVEF pre‐ablation were analyzed for assessing LV systolic function recovery, defined as LVEF increase of ≥20% or to a value ≥55% after ablation. Results: A total of 120 patients (2017–2020) were included. After 19 ±14 months post ablation, LVEF improvement was similar in patients with normal or dilated LV (18.3 ± 9.4% vs. 16.1 ± 10.8%, P =.25), rapid or controlled HR (19.5 ± 10% vs. 16.1 ± 10%, P =.09), but higher in HFrEF (HF with reduced EF) than HFmrEF (HF with midrange EF) (21.6 ± 10.3% vs. 14.9 ± 9.3%, P <.01). There was more LV systolic function recovery in those with normal to moderate LV dilation (80%, odds ratio [OR] 15.22, P <.01), HR ≥80 bpm (79%, OR 5.38, P <.01) and HFmrEF (80%, OR 4.03, P <.01). The overall AF freedom was similar between normal and dilated LV (59% vs. 62%, P =.95), rapid and controlled HR (67% vs. 56%, P =.18), and HFmrEF and HFrEF (65% vs. 50%, P =.19). Conclusion: Catheter ablation is effective independent of LV dilation, rate control or HFrEF. Patients with normal to moderate LV dilation, resting HR ≥80 bpm and HFmrEF may be candidates for early PerAF ablation to achieve LVEF normalization. [ABSTRACT FROM AUTHOR]

Background: Contraction of the esophagus was observed during cryoablation for paroxysmal atrial fibrillation (PAF). The purpose of this study is to investigate the mechanism of esophageal contraction and the correlation between the contraction and esophageal thermal lesions. Methods: This prospective study enrolled 64 patients with PAF undergoing second‐generation cryoballoon (CB2) ablation for pulmonary vein isolation (PVI). During PVI for the left inferior pulmonary vein, contrast esophagography was performed before and during cryoablation. The sample population was divided into two groups: A (31 patients) and B (33 patients). Group A consisted of patients in whom the distal half of the CB was in proximity to the esophagus, while for group B the esophagus was away from the distal half of the CB. Esophageal contraction was recorded as a variation in the width of the esophageal lumen during PVI. Postablation esophageal endoscopy was done on all patients. Results: The reduction in the width of the esophageal lumen in group A was greater than in group B during freezing (40.12 ± 23.24% vs 8.14 ± 10.35%, P <.001). Following endoscopy, no apparent esophageal lesion was detected in all patients. Conclusion: The extent of esophageal contraction is correlated with the positioning of the esophagus at the distal half of the CB. The findings of this study indicate that esophageal contraction during freezing may be a self‐protective mechanism. [ABSTRACT FROM AUTHOR]