Background: Application of electrocautery to a J-wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique. Methods: 200 consecutive patients were randomized in a 1:1 fashion to either the ICE-guided electrified J-wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20W, “coag” mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time. Results: All patients complete the procedure safely. The electrified J-wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra-atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the 2 groups (3/32 patients in the J-wire TSP group and 2/26 patients in conventional BRK TSP group, p=0.82). And no difference in the incidence of residual intra-atrial shunt (4.3% versus 6%, p=0.654) during the 3-month’s follow up. Conclusion: Using an electrified J-wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non-fluoroscopy AF ablation.

Aims: Left bundle branch pacing (LBBP) upgrade can improve cardiac function and clinical outcomes in patients with pacing-induced cardiomyopathy (PICM), but the specific value especially compared with the level before right ventricular pacing (RVP) in patients with PICM and non-pacing-induced cardiomyopathy (Non-PICM) is still unknown. Methods: This study retrospectively enrolled 108 patients with LBBP upgrade (38 patients with PICM and 70 patients with Non-PICM). PICM patients were defined as patients who had a normal left ventricular function and a > 10% decrease in LVEF after RVP, among patients experiencing > 40% RVP, when other organic heart diseases were excluded. Non-PICM patients were defined as patients requiring pacemaker upgrades with non-decreased cardiac function reasons, such as battery exhaustion, pacing system infection, and right ventricular lead failure. All upgrade patients experienced three stages: before RVP (Pre-RVP), before LBBP upgrade (Pre-LBBP), and after LBBP upgrade (Post-LBBP). QRS duration (QRSd) , lead parameters, echocardiographic indicators, and clinical outcomes evaluation were recorded at multiple time points. Univariable analysis of variance and Mann-Whitney U-tests for repeated measures were used to assess the effects of the LBBP upgrade. Results: At the follow-up of 12 months, for PICM patients, left ventricular ejection fraction (LVEF) significantly increased from 36.6 ± 7.2% at Pre-LBBP to 51.3 ± 8.7% after LBBP upgrade (P < 0.001), and left ventricular end-diastolic diameter (LVEDD) significantly decreased from 61.5 ± 6.4mm at Pre-LBBP to 55.2 ± 6.5mm after LBBP upgrade (P < 0.001), besides, New York Heart Association (NYHA) classification improved from 3.16 ± 0.82 at Pre-LBBP to 1.76 ± 0.88 after LBBP upgrade (P < 0.001), but they all failed to restore the level of the initial status before RVP (LVEF: 51.3 ± 8.7% vs 60.3 ± 7.6%, P < 0.001) (LVEDD: 55.2 ± 6.5mm vs 49.7 ± 6.1mm, P < 0.001) (NYHA:1.76 ± 0.88 vs 1.11±0.31, P < 0.001). Furthermore, for PICM patients, the number of moderate-to-severe heart failure (HF) (NYHA III-IV) and diuretics used after the LBBP upgrade also could not restore the level before RVP (P = 0.002 and P = 0.004). At the follow-up of 12 months, Non-PICM patients after the LBBP upgrade had no significant improvement in LVEF, LVEDD, NYHA classification (LVEF: P = 0.521; LVEDD: P = 0.383; NYHA classification: P = 0.279) and no difference compared with Pre-RVP (LVEF: P = 0.559; LVEDD: P = 0.952; NYHA classification: P = 0.942). Conclusion: LBBP upgrade effectively improved the cardiac function and clinical outcomes in PICM patients but failed to restore the functional levels before RVP. For Non-PICM patients, the cardiac function and clinical outcomes after the LBBP upgrade had no significant difference when compared to Pre-RVP and Pre-LBBP.