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Background Transvenous lead extraction (TLE) may be necessary due to infective and noninfective indications. We aim to identify predictors of 30‐day mortality and risk factors between infective versus noninfective groups and systemic versus local infection subgroups. Methods A total of 925 TLEs between October 2000 and December 2016 were prospectively collected and dichotomized (infective group n = 505 vs noninfective group n = 420 and systemic infection n = 164 vs local infection n = 341). Results All‐cause major complication including deaths was significantly higher (5.1%, n = 26 vs 1.2%, n = 5, P = 0.001) as well as 30‐day mortality (4.0%, n = 20 vs 0.2%, n = 1, P < 0.001) in the infective group compared to the noninfective group. Both subgroups (systemic vs local infection) were balanced for demographics. All‐cause major complication including deaths was significantly higher (9.1%, n = 15 vs 3.2%, n = 11, P = 0.008) as well as all‐cause 30‐day mortality (7.9%, n  = 13 vs 2.1%, n = 7, P = 0.003) in the systemic infection subgroup compared to the local infection subgroup. Conclusion Patients undergoing TLE for infective indications are at greater risk of 30‐day all‐cause mortality compared to noninfective patients. Patients undergoing TLE for systemic infective indications are at greater risk of 30‐day all‐cause mortality compared to patients with local infection. Renal impairment, systemic infection, and elevated preprocedure C‐reactive protein are independent predictors of 30‐day all‐cause mortality in patients undergoing TLE for an infective indication.

Bradycardia, atrial stretch and dilatation, autonomic nervous system disorders, and the presence of triggers such as atrial premature contractions, are factors which predispose a person to paroxysmal AF. Atrial pacing not only eliminates bradycardia but also prevents atrial premature contractions and dispersion of refractoriness, which are a substrate for atrial fibrillation. As the prolonged duration of atrial activation during pacing, especially from locations changing the physiological pattern of this activation (right atrium lateral wall, right atrium appendage), negatively influences both a mechanical and an electrical function of the atria, the atrial pacing site affects an atrial arrhythmogenesis. A conventional atrial lead location in the right atrium appendage causes non-physiological activation propagation, resulting in a prolongation of the activation time of both atria. This location is optimal according to a passive fixation of the atrial lead but the available contemporary active fixation leads could potentially be located in any area of the atrium. There is growing evidence of the benefit of pacing, imitating the physiological propagation of impulses within the atria. It seems that the Bachmann's bundle pacing is the best pacing site within the atria, not only positively influencing the atrial mechanical function but also best fulfilling the so-called atrial resynchronization function, in particular in patients with interatrial conduction delay. It can be effectively achieved using only one atrial electrode, and the slight shortening of atrioventricular conduction provides an additional benefit of this atrial pacing site.

in a surface electrocardiogram. A slower inter atrial conduction takes place in the coronary si nus. The physiological left atrial contraction de lay amounts to 22 ± 11 ms in relation to the right atrium [1][2][3].The interatrial conduction disorders are rela tively common in sick sinus syndrome patients, which contribute to atrial arrhythmias, in par The implantation of a permanent pacemaker alters the electrophysiological and hemodynam ic relations in a heart. The electrical physiologi cal activation of the atria comes from the sino atrial node. The left atrium activation is achieved throughout the conductive tissue layer called the Objectives. This study was aimed to assess the influence of the atrial pacing site on interatrial and atrioventricular conduction as well as the percentage of ventricular pacing in patients with sick sinus syndrome implanted with atrioventricular pacemaker. Material and Methods. The study population: 96 patients (58 females, 38 males) aged 74.1 ± 11.8 years were divided in two groups: Group 1 (n = 44) with right atrial appendage pacing and group 2 (n = 52) with Bachmann's area pacing. We assessed the differences in atrioventricular conduction in sinus rhythm and atrial 60 and 90 bpm pacing, Pwave duration and percentage of ventricular pacing. Results. No differences in baseline Pwave duration in sinus rhythm between the groups (102.4 ± 17 ms vs. 104.1 ± 26 ms, p = ns.) were noted. Atrial pacing 60 bpm resulted in longer Pwave in group 1 vs. group 2 (138.3 ± 21 vs. 106.1 ± 15 ms, p < 0.01). The differences between atrioventricular conduction time during sinus rhythm and atrial pacing at 60 and 90 bpm were significantly longer in patients with right atrial appendage vs. Bachmann's pacing (44.1 ± 17 vs. 9.2 ± 7 ms p < 0.01 and 69.2 ± 31 vs. 21.4 ± 12 ms p < 0.05, respectively). The percentage of ventricular pacing was higher in group 1 (21 vs. 4%, p < 0.01). Conclusions. Bachmann's bundle pacing decreases interatrial and atrioventricular conduction delay. Moreover, the frequencydependent atrioventricular conduction lengthening is much less pronounced during Bachmann's bundle pacing. Right atrial appendage pacing in sick sinus syndrome patients promotes a higher percentage of ventricular pacing (Adv Clin Exp Med 2016, 25, 5, 845-850).

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Despite its widely-understood physiological mode, artificial atrial pacing can negatively influence heart performance in many respects. We present the case of an 80-year-old woman with the signs and symptoms of diastolic heart failure which had originated, according to the patient herself, due to the implantation of a dual chamber pacemaker inserted for the treatment of sinus node disease. The atrial electrode was located in the right atrial appendage. Electrocardiographic and echocardiographic assessment indicated the possibility of a deleterious relationship between the atrial and ventricular contraction, which could be responsible for patient's symptoms. Some changes in device programming could contribute to a clinical improvement. Yet the question remains: should pacing of the Bachmann's bundle be implemented in our patient?