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A 33‐year‐old man with an EMBLEM S‐ICD (Model 3501) experienced complete lead transection. Despite preserved secondary‐vector sensing, the lead was safely extracted using silk‐suture extension and a Byrd sheath, illustrating stepwise lead injury and a simple extraction strategy.

This case discusses the retrieval of a pacemaker with vegetation from a 78‐year‐old man. It suggests that grasping side of Micra body and pulling Micra into Agilis sheath is a possible technique for retrieval.

Transseptal catheter ablation resolved ventricular arrhythmias originating from the left ventricular outflow tract following transcatheter aortic valve implantation with a self‐expanding Evolut valve. This report highlights the transseptal approach as a safe and effective alternative, overcoming the structural complexities of self‐expanding valves while reducing procedural risks and preserving valve integrity.

•Subclinical hemolysis after TAVI has occasionally been documented.•Decompensated hemolytic anemia requiring specific treatment has been rare.•The incidence of hemolytic anemia after TAVI using S3UR was not negligible.•PVL ≥ mild was associated with an increased risk of hemolytic anemia. Decompensated hemolytic anemia after transcatheter aortic valve implantation (TAVI) requiring specific treatment is rarely encountered in actual clinical practice. Nevertheless, there have been several cases of clinically relevant hemolytic anemia following implantation of the recently launched SAPIEN 3 Ultra RESILIA (S3UR). This study aimed to elucidate the clinical features of hemolytic anemia following S3UR implantation. Patients who underwent TAVI using S3UR from the end of March 2023 to November 2023 were enrolled from the Japanese multicenter OCEAN (Optimized CathEter vAlvular iNtervention)–TAVI registry. Hemolytic anemia was defined as (1) a drop in hemoglobin level by >2.0 g/dL within 3 months after the index TAVI procedure and (2) the diagnosis of mechanical hemolysis as the cause of anemia made by the attending physician and hematologist based on the presence of any 2 of the following criteria: (1) serum lactate dehydrogenase level >220 IU/L; (2) haptoglobin level <0.5 g/L; and (3) reticulocyte count ≥2%. Of the 1,070 patients, 18 (1.7%) patients developed hemolytic anemia after TAVI. These patients had a significantly lower prosthesis oversizing relative to native annulus (−3.7% [−5.9% to 0.1%] vs 7.5% [0.6% to 14.0%], p <0.001) and a higher prevalence of paravalvular leakage (PVL) ≥mild (mild PVL: 61.1% vs 12.4%; moderate-to-severe PVL: 16.7% vs 0.2%; p <0.001) than those without hemolytic anemia. PVL ≥mild was associated with a higher incidence of hemolytic anemia particularly in patients with oversizing of <−5% (33.3% vs 1.3%, p <0.001) and in those with −5%≤ oversizing <10% (8.3% vs 0.7%, p <0.001). In conclusion, the incidence of decompensated hemolytic anemia after S3UR implantation was not negligible, and the results of the present study support the importance of selecting a prosthesis size with a sufficient oversizing relative to native annulus to minimize residual PVL ≥mild leading to hemolytic anemia after TAVI. [Display omitted]

Recent studies suggested short-term mortality after transcatheter edge-to-edge repair (TEER) was comparable between men and women. However, the gender-specific prognostic difference in the long-term follow-up after TEER is still unknown. To evaluate the impact of gender on long-term mortality after TEER for functional mitral regurgitation (FMR) using multicenter registry data. We retrospectively analyzed 1,233 patients (male 60.3%) who underwent TEER for FMR at 24 centers. The impact of gender on all-cause death and hospitalization for heart failure (HF) after TEER was evaluated using multivariate regression analysis and propensity score (PS) matching methods. During the 2-year follow-up, 207 all-cause death and 263 hospitalizations for HF were observed after TEER for FMR. Men had a significantly higher incidence of all-cause death than women (18.6% vs 14.1%, log-rank p = 0.03). After adjustment by multivariate Cox regression and PS matching, the male gender was significantly associated with a higher incidence of all-cause mortality after TEER than the female gender (hazard ratio 2.11, 95% confidence interval 1.42 to 3.14 in multivariate Cox regression; hazard ratio 1.89, 95% confidence interval 1.03 to 3.48 in PS matching). The gender-specific prognostic difference was even more pronounced after 1-year of TEER. On the contrary, there was no gender-related difference in hospitalization for HF after TEER. In conclusion, women with FMR had a better prognosis after TEER than men, whereas this was not observed in hospitalization for HF. This result might indicate that women with FMR are more likely to benefit from TEER.

Key Clinical Message The left atrial roof vein provides a stable and reproducible anchoring site for cryoballoon positioning, thereby facilitating effective and durable left atrial roof block creation in situations where conventional anchoring within the superior pulmonary veins is insufficient or unstable.

Background Femoropopliteal diffuse calcified occlusions (FPDCOs) are challenging, especially in high-bleeding-risk patients for whom a stentless strategy is preferred. We introduce FRAP-CROSS, combining Fracking and Rendezvous-PIERCE, to achieve intracalcium guidewire crossing and facilitate stentless revascularization. Materials and methods When bidirectional intracalcium wiring fails across dense calcification in FPDCO, FRAP-CROSS is applied. Fracking is initially performed by inserting a 20-gauge metal needle into a guidewire-uncrossable plaque and applying hydraulic pressure to create microfractures, facilitating subsequent guidewire crossing. If device tracking remains unsuccessful after guidewire passage, Rendezvous-PIERCE is employed. An 18-gauge needle is advanced toward the intralesional guidewire tip, and the guidewire is externalized through the needle (Needle Rendezvous). A 20-gauge needle is then advanced over the externalized guidewire to create a lumen within the calcification (inner PIERCE). After successful all-intracalcium crossing, balloon angioplasty is performed. Inadequate expansion prompts additional Fracking alone or with Jetstream atherectomy (JET-Frack). Drug-coated balloon (DCB) angioplasty completes the stentless strategy. Results A 90-year-old man at high bleeding risk with bilateral FPDCOs underwent FRAP-CROSS. The right limb required three Fracking and two Rendezvous-PIERCE; the left required four Fracking and two Rendezvous-PIERCE, respectively, with adjunctive JET-Frack. Following DCB-based stentless treatment, final angiography and intravascular ultrasound confirmed adequate luminal expansion and blood flow in both limbs, without major complications. Conclusion FRAP-CROSS provides a practical approach to achieve all-intracalcium guidewire crossing and stentless revascularization in complex FPDCOs. Further studies should assess its safety and long-term outcomes. Graphical Abstract

Background: Percutaneous left atrial appendage closure (LAAC) reduces the incidence of stroke/bleeding events in patients with non-valvular atrial fibrillation, high risk of stroke, and contraindication in continuing anticoagulation therapy. Of them, patients with heart failure may remain at high risk of these events after LAAC. Method: Patients who underwent LAAC and were listed for the multi-center, prospectively collected OCEAN-LAAC registry, were eligible. Of them, individuals without baseline plasma B-type natriuretic peptide (BNP) levels and those dependent on hemodialysis were excluded. The prognostic impact of baseline plasma BNP levels on the incidence of death or stroke/bleeding events after LAAC was evaluated. Results: A total of 937 patients (median 78 years, 596 men) were included. The LAAC device was successfully implanted in 934 (98%) patients. Over the 366 (251, 436) days after the LAAC, 148 patients encountered a primary outcome. The common logarithm of baseline plasma BNP was independently associated with the primary outcome with an adjusted hazard ratio of 1.46 (95% confidence interval 1.06–2.18, p = 0.043). A calculated cutoff of 2.12 (equivalent to 133 pg/mL of plasma BNP level) significantly stratified the cumulative incidence of the primary outcome (29% vs. 21% for 2 years, p = 0.004). Conclusions: Using prospectively collected large-scale multi-center Japanese registry data, we demonstrated that a baseline higher plasma BNP level was independently associated with a higher incidence of stroke/bleeding events and mortality after LAAC. Further studies are warranted to understand the optimal therapeutic strategy for LAAC candidates with elevated baseline plasma BNP levels.