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Background To describe the performance and clinical outcomes of consecutive patients having a leadless pacemaker (LP) implanted at a single institution. Methods Clinical data and device parameters were prospectively collected on all patients undergoing LP implantation from November 2015 to April 2018. Results A total of 79 patients (52 male), median age of 78 years, was included. Leadless pacemaker implantation was successful in 76 patients (96%). Implantation failed in two patients due to excessive venous tortuosity and due to inadequate sensing in another. Seventy-three (73) patients (96%) had chronic atrial fibrillation and all had a Class I or II indication for pacing. Procedure time was 29 minutes (IQR 21–43) and fluoroscopy time was 8 minutes (IQR 5–13). The median R wave at implant was 11.2 mV (IQR 6.9–15.0). The median capture threshold at 0.24 ms was 0.5 V (IQR 0.4–0.9) and impedance was 754 Ω (IQR 680–880). Intraprocedural acute dislodgement occurred in one patient following cutting of the tether but successful snaring and reimplantation was performed. During a median follow-up of 355 days (range 9–905), overall electrical performance has been excellent. No patients have been readmitted for device revision or complications. Five (5) patients (7%) died during follow-up from unrelated causes. Conclusions Leadless pacemakers can be implanted safely and effectively in the majority of patients. Device electrical performance was excellent over a median follow-up of 12 months.

Introduction: Pulmonary vein reconnection is a major limitation of pulmonary vein isolation (PVI) for symptomatic atrial fibrillation (AF). Adenosine may unmask dormant PV conduction and facilitate consolidation of PV isolation. We performed a systematic review of the literature to determine the impact of routine adenosine administration on clinical outcomes in patients undergoing PVI. Methods: References and electronic databases reporting AF ablation and adenosine following PVI were searched through to 31st July 2012. Six studies included 544 patients to assess the impact of catheter ablation to target adenosine induced PV reconnection on AF ablation outcome and three studies included 612 patients to assess the impact of adenosine testing on AF ablation outcome. Relative risks were calculated and combined in a meta-analysis using random effects modelling. Results: Routine adenosine testing for PV reconnection with additional targeted ablation resulted in a significant increase in freedom from AF post PVI (RR 1.25; 95% CI 1.12–1.40; p< 0.001). However, within the group of patients undergoing adenosine testing, those with reconnection identified a population with a trend to reduction in freedom from AF despite the use of further targeted ablation in the reconnection group (RR 0.91 with 95% CI 0.81–1.03; p= 0.15). Conclusion: Routine adenosine testing is associated with an improvement in freedom from AF post PVI. Paradoxically acute adenosine induced PV reconnection may portend a greater likelihood of AF recurrence despite additional ablation. Randomised controlled trials are required to determine the role of adenosine testing post PVI.

Introduction: Pulmonary vein reconnection is a major limitation of pulmonary vein isolation (PVI) for symptomatic atrial fibrillation (AF). Adenosine may unmask dormant PV conduction and facilitate consolidation of PV isolation. We performed a systematic review of the literature to determine the impact of routine adenosine administration on clinical outcomes in patients undergoing PVI. Methods: References and electronic databases reporting AF ablation and adenosine following PVI were searched through to 31st July 2012. Six studies included 544 patients to assess the impact of catheter ablation to target adenosine induced PV reconnection on AF ablation outcome and three studies included 612 patients to assess the impact of adenosine testing on AF ablation outcome. Relative risks were calculated and combined in a meta-analysis using random effects modelling. Results: Routine adenosine testing for PV reconnection with additional targeted ablation resulted in a significant increase in freedom from AF post PVI (RR 1.25; 95% CI 1.12–1.40; p< 0.001). However, within the group of patients undergoing adenosine testing, those with reconnection identified a population with a trend to reduction in freedom from AF despite the use of further targeted ablation in the reconnection group (RR 0.91 with 95% CI 0.81–1.03; p= 0.15). Conclusion: Routine adenosine testing is associated with an improvement in freedom from AF post PVI. Paradoxically acute adenosine induced PV reconnection may portend a greater likelihood of AF recurrence despite additional ablation. Randomised controlled trials are required to determine the role of adenosine testing post PVI.

lowed up for a period of 610± 536 days. No patient with AT had further AF. One of two patients with slow fast AVNRT had AF reoccurrence and underwent PVI. Five of 10 patients with induced atrial flutter underwent repeat ablation for AF reoccurrence. Conclusion: A significant proportion of young patients presenting with AF have a supra-ventricular tachycardia. Ablation of focal atrial tachycardia or AVNRT prevented AF reoccurrence. In contrast, if the induced arrhythmia was macro-reentry, AF was more common during follow up. In young patients, we advocate the evaluation for a treatable supra-ventricular arrhythmia. http://dx.doi.org/10.1016/j.hlc.2013.05.288