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Updates on Cardiac Pacing and Electrophysiology
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Updates on Cardiac Pacing and Electrophysiology

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 May 2026 | Viewed by 4730

Special Issue Editor

Prof. Dr. Axel Brandes

E-Mail Website
Guest Editor
Department of Cardiology, Esbjerg Hospital-University Hospital of Southern Denmark, Esbjerg, Denmark
Interests: atrial fibrillation; pacemakers; electrocardiography; pharmacology; cardiology; heart failure; echocardiography; clinical cardiology; cardiomyopathies

Special Issue Information

Dear Colleagues,

In recent years, substantial progress has been made in cardiac pacing and clinical electrophysiology. New technologies and innovative approaches have emerged and entered the clinical arena. Some have already become established treatment options, while others are still under development, and more evidence from clinical studies is warranted.

This Special Issue will provide state-of-the-art novel results of pacemaker and implantable cardioverter–defibrillator therapy, including conduction system pacing, leadless pacemakers, extravascular ICD and lead extraction. Moreover, we will provide a comprehensive state of the art of the invasive treatment of supraventricular and ventricular tachycardia, including new diagnostic tools and treatment modalities, as well as clinical results. This will also include cardio-neuro ablation for the treatment of non-cardiac syncope.

Researchers in the field of cardiac pacing and clinical electrophysiology are encouraged to submit review articles giving a critical appraisal of the current status of new, innovative approaches and novel technologies, as well as original articles presenting clinical outcome studies within the field.

Prof. Dr. Axel Brandes
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pacemaker
  • conduction system pacing
  • leadless pacemaker
  • implantable cardioverter–defibrillator
  • ICD
  • extravascular ICD
  • S-ICD
  • lead extraction
  • supraventricular tachycardia
  • ventricular tachycardia
  • cardio-neuro ablation

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Published Papers (5 papers)

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Research

Jump to: Review

12 pages, 2547 KB  
Article
Single-Center Real World Experience with the VARIPULSE Platform for Pulsed Field Ablation of Atrial Fibrillation, Atrial Flutter, and Redo Procedures
by Nizar Andria, Ziad Abuiznait, Mussa Saad, Samer Yousef, Sergey Keselman and Ibrahim Marai
J. Clin. Med. 2026, 15(1), 28; https://doi.org/10.3390/jcm15010028 - 20 Dec 2025
Viewed by 229
Abstract
Background/Objectives: Pulsed field ablation (PFA) is increasingly used for pulmonary vein isolation (PVI). One of the emerging single-shot PFA catheters is the variable-loop circular catheter (VARIPULSE™, Biosense Webster, Inc.) which is fully integrated into a three-dimensional mapping system. However, the evidence for [...] Read more.
Background/Objectives: Pulsed field ablation (PFA) is increasingly used for pulmonary vein isolation (PVI). One of the emerging single-shot PFA catheters is the variable-loop circular catheter (VARIPULSE™, Biosense Webster, Inc.) which is fully integrated into a three-dimensional mapping system. However, the evidence for the feasibility of ablation of non-pulmonary vein targets is still limited using the VARIPULSE catheter. In this study, we summarize our experience in PVI and mapping/ablation of non-pulmonary vein sites in patients with atrial fibrillation (AF) and complex atrial substrate and arrhythmias using the VARIPULSE catheter. Methods: All patients with paroxysmal or persistent AF who underwent catheter ablation using the VARIPULSE catheter were retrospectively included. PVI was performed in all patients. Spontaneous or inducible atrial flutters were mapped and ablated. Empiric lines were performed at the operator’s discretion. Acute outcomes and complications were analyzed. Results: the study included 60 patients; 25 (41.6%) were females and mean age was 67.15 ± 9.01 years. Thirty four (60%) had persistent AF and six (10%) patients had atrial flutter as the initial rhythm during the index procedure. All patients had PVI using the PFA as per protocol. Most of the patients (76.7%) had non-pulmonary vein ablation sites; posterior wall isolation was performed in 25 (41.7%) patients, roof line in 9 (15%) patients, anterior line in 16 (26.7%) patients, cavotricupsid isthmus in 11 (18.3%) patients and superior vena cava isolation in two (3.3%) patients. Overall, 27 patients had atrial flutters during the index procedure that were mapped and ablated using the VARIPULSE catheter. All had termination of atrial flutter except for one patient. Major complications were not detected. Conclusions: Mapping and ablation of atypical atrial flutter and non-pulmonary vein targets are feasible and safe using the VARIPULSE platform. Full article
(This article belongs to the Special Issue Updates on Cardiac Pacing and Electrophysiology)
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15 pages, 1130 KB  
Article
Comparative Analysis of Two-Lead DX-Based CRT Versus Conventional Three-Lead CRT-D: Results from a Single-Center Prospective Study
by Alessandro Carecci, Mauro Biffi, Mirco Lazzeri, Andrea Quaranta, Lorenzo Bartoli, Alberto Spadotto, Cristian Martignani, Andrea Angeletti, Igor Diemberger, Giulia Massaro and Matteo Ziacchi
J. Clin. Med. 2025, 14(24), 8746; https://doi.org/10.3390/jcm14248746 - 10 Dec 2025
Viewed by 266
Abstract
Background/Objectives: Cardiac resynchronization therapy with defibrillator (CRT-D) is a well-established therapy for patients with heart failure (HF) and intraventricular conduction delays, but a non-negligible risk of infection and of lead functionality loss overtime is related to intravascular hardware. The novel DX system [...] Read more.
Background/Objectives: Cardiac resynchronization therapy with defibrillator (CRT-D) is a well-established therapy for patients with heart failure (HF) and intraventricular conduction delays, but a non-negligible risk of infection and of lead functionality loss overtime is related to intravascular hardware. The novel DX system enables atrial sensing through a floating dipole integrated into the ICD lead, reducing the intravascular burden. In this prospective non-randomized study, we aimed to evaluate the safety and efficacy of a two-lead DX-based CRT system compared to a conventional three-lead (3L) CRT-D system. Methods: A total of 210 patients meeting CRT indications and no signs of sick sinus syndrome (SSS) (baseline HR ≥ 45 bpm, or at least 85 bpm at 6 min walking test) were enrolled. Patients were assigned to either the CRT-DX or conventional 3L CRT-D group. The primary endpoint was a composite clinical response, defined as the freedom from cardiovascular death, HF hospitalization, or new-onset atrial fibrillation (AF). Results: After a mean follow-up of 46.5 ± 1.9 months, both groups had comparable clinical and instrumental outcomes. CRT-DX patients exhibited higher atrial sensing amplitudes and no significant differences in loss of lead function. Conclusions: In conclusion, the CRT-DX system provides equivalent clinical and echocardiographic benefits compared to conventional CRT-D in patients without an indication for atrial pacing. This supports the use of the DX system as a safe and effective alternative in the majority of CRT recipients. Full article
(This article belongs to the Special Issue Updates on Cardiac Pacing and Electrophysiology)
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11 pages, 1337 KB  
Article
Impact of Atrial Lead Position on Functional Cardiac Parameters in Patients Requiring Dual-Chamber Pacemaker Implantation
by Sarah X. Gharibeh, Valerie Jochmann, Istvan Szendey, Peter Jirak, Albert Topf, Dorothee Ladage, Uta C. Hoppe, Lars Eckardt, Emmanuel Chorianopoulos, Lukas J. Motloch and Robert Larbig
J. Clin. Med. 2025, 14(7), 2278; https://doi.org/10.3390/jcm14072278 - 27 Mar 2025
Cited by 1 | Viewed by 1156
Abstract
Background: In patients requiring dual-chamber pacemaker (DDD) implantation, optimal atrial lead position remains a matter of debate. While most centers prefer implantation in the right atrial appendage position (Non-BB-P), due to a speculated favorable impact on atrial conduction characteristics, often, a Bachman bundle [...] Read more.
Background: In patients requiring dual-chamber pacemaker (DDD) implantation, optimal atrial lead position remains a matter of debate. While most centers prefer implantation in the right atrial appendage position (Non-BB-P), due to a speculated favorable impact on atrial conduction characteristics, often, a Bachman bundle pacing (BB-P) is recommended. However, data investigating clinical outcomes in these patients are still rare. Methods: To evaluate this issue, in this retrospective single-center study, one-year clinical follow-up, pacemaker interrogations and available echocardiography findings in 301 consecutive patients (BB-P: age 76 ± 10 years, 46.7% female, n = 169; Non-BB-P: 77.6 ± 9 years, 50% female, n = 132, p = n.s.) scheduled for dual-chamber implantation were analyzed. Results: During follow-up, the incidence of atrial fibrillation (AF) remained similar in both groups (BB-P: 38.3%, n = 154 vs. Non-BB-P: 34.2%, n = 117 p = n.s.). However, we detected significantly more mode switch episodes in the BB-P group (BB-P: 51.9%, n = 154 vs. Non-BB-P: 38.8%, n = 116, p = 0.032). Furthermore, left ventricular functional parameters, including left ventricular ejection fraction (BB-P: 57.1 ± 8.4%, n = 60 vs. Non-BB-P: 56.0 ± 9.6, n = 45 p = n.s.) and incidence of diastolic dysfunction (BB-P: 55.2%, n = 67 vs. Non-BB-P: 38.3%, n = 47, p = n.s.), as well as the rate of left (BB-P: 58.8%, n = 68 vs. Non-BB-P: 42.0%, n = 50, p = n.s.) and right atrial dilatation (BB-P: 27.9%, n = 68 vs. Non-BB-P: 28.0%, n = 50 p = n.s.), were not significantly affected by the atrial lead position. However, stimulated p-waves were significantly shorter in BB-P vs. Non-BB-P (BB-P: 132.9 ± 23.7 ms, n = 127 vs. Non-BB-P: 139.6 ± 23.4 ms, n = 93, p = 0.031). Conclusions: In patients requiring dual-chamber implantation, the position of the atrial lead significantly altered atrial conduction, but this did not seem to affect left ventricular function parameters or the occurrence of atrial fibrillation within our follow-up period. Interestingly, we even detected more mode switch episodes in the BB-P group, hinting at an even proarrhythmic potential of BB-P. On the other hand, we found a decreased ventricular stimulation percentage in BB-P vs. Non-BB-P. Further studies should investigate the impact of Bachmann bundle pacing on clinical outcomes. Full article
(This article belongs to the Special Issue Updates on Cardiac Pacing and Electrophysiology)
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12 pages, 2206 KB  
Article
Leadless Pacemaker vs. Transvenous Pacemaker in End Stage Kidney Disease: Insights from the Nationwide Readmission Database
by Sajog Kansakar, Azka Naeem, Norbert Moskovits, Dhan Bahadur Shrestha, Jurgen Shtembari, Monodeep Biswas, Ghanshyam Shantha, Binaya Basyal, James Storey and Daniel Katz
J. Clin. Med. 2025, 14(1), 202; https://doi.org/10.3390/jcm14010202 - 2 Jan 2025
Cited by 1 | Viewed by 1712
Abstract
Background: Leadless pacemakers offer a safe and effective alternative pacing strategy. However, limited data are available for patients with end stage renal disease (ESRD), a population of significant relevance. Methods: Using the Nationwide Readmission Database, we extracted data from all adult patients [...] Read more.
Background: Leadless pacemakers offer a safe and effective alternative pacing strategy. However, limited data are available for patients with end stage renal disease (ESRD), a population of significant relevance. Methods: Using the Nationwide Readmission Database, we extracted data from all adult patients with ESRD who underwent traditional transvenous or leadless pacemaker implantation between 2016 and 2021. We compared in-hospital mortality, 30-day readmission rates, complication rates, and healthcare resource utilization between the two cohorts. Results: A total of 6384 (81.2%) patients were included in the transvenous pacemaker cohort, and 1481(18.8%) patients were included in the leadless pacemaker cohort. In patients with ESRD, leadless pacemaker implantation was linked to higher in-hospital complications when compared to transvenous pacemakers. These included the need for blood transfusion (aOR 1.85, 95% CI 1.32–2.60, p < 0.01), vascular complications (aOR 3.6, CI 1.40–9.26, p = 0.01), and cardiac complications (aOR 4.12, CI 1.70–9.98, p < 0.01). However, there were no differences between the two groups in terms of in-hospital mortality and 30-day readmission rates. The median length of stay was longer for leadless pacemaker implantation than transvenous pacemaker implantation (5 days vs. 4 days, p < 0.01). The total hospitalization charges were also higher ($139,826 vs. $93,919, p < 0.01). Conclusions: Although previous studies have demonstrated lower long-term complication rates with leadless pacemakers than transvenous pacemakers, our analysis shows a higher risk of short-term in-hospital complications in ESRD patients, though no differences in in-hospital mortality and 30-day readmissions. Full article
(This article belongs to the Special Issue Updates on Cardiac Pacing and Electrophysiology)
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Review

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18 pages, 4240 KB  
Review
Leadless Pacemakers in Complex Congenital Heart Disease
by Archana Rao, Elen Hughes, Milos Prica, Sadaf Raza, Mohammed Saber and Reza Ashrafi
J. Clin. Med. 2025, 14(23), 8560; https://doi.org/10.3390/jcm14238560 - 2 Dec 2025
Viewed by 367
Abstract
Pacing in complex congenital heart disease can be difficult and with significant drawbacks due to issues with infection and long-term leads within the vasculature. Leadless pacemakers have emerged as a new technology with a strong safety and efficacy record in normal cardiac anatomy. [...] Read more.
Pacing in complex congenital heart disease can be difficult and with significant drawbacks due to issues with infection and long-term leads within the vasculature. Leadless pacemakers have emerged as a new technology with a strong safety and efficacy record in normal cardiac anatomy. Here, we review the current available technology, current evidence in complex congenital pacing and how leadless pacemakers may be used in complex congenital heart disease. Full article
(This article belongs to the Special Issue Updates on Cardiac Pacing and Electrophysiology)
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