{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T23:55:06Z","timestamp":1781826906793,"version":"3.54.5"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sinus node dysfunction (SND) is a well-recognized complication after orthotopic heart transplantation (OHT), particularly in recipients of biatrial anastomosis. In this setting, conventional transvenous pacing may be technically challenging due to complex post-surgical anatomy and increased infection risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 36-year-old woman with restrictive cardiomyopathy underwent successful biatrial OHT. Eleven months later, she presented with persistent junctional rhythm and exertional fatigue. Electrophysiological study confirmed electrical dissociation between the donor and recipient atria with preserved atrioventricular conduction but absent sinus activity. Considering her immunosuppressed status and challenging anatomy, a leadless atrial pacemaker (Aveir AR, Abbott) was implanted under three-dimensional computed tomography (CT)\u2013fluoroscopy fusion guidance. The device was positioned at the base of the donor right atrial appendage, achieving optimal electrical parameters. The procedure was completed without complications, and at follow-up, the patient showed complete symptom resolution and improved chronotropic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates the feasibility and safety of CT\u2013fluoroscopy\u2013guided leadless atrial pacing in a post-transplant recipient with persistent SND, highlighting the value of advanced imaging for accurate spatial orientation and device deployment in complex post-surgical anatomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag411","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:32:06Z","timestamp":1780399926000},"source":"Crossref","is-referenced-by-count":0,"title":["Persistent sinus node dysfunction after biatrial heart transplantation successfully managed with CT-guided leadless atrial pacing: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8824-4868","authenticated-orcid":false,"given":"Raimondo","family":"Pittorru","sequence":"first","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova , Via N. Giustiniani 2, 35128 Padova ,","place":["Italy"]},{"name":"Institut Cl\u00ednic Cardiovascular, Hospital Cl\u00ednic, Universitat de Barcelona , Carrer de Villaroel 170, 08036 Catalonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6864-9372","authenticated-orcid":false,"given":"Mariona","family":"Regany-Closa","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular, Hospital Cl\u00ednic, Universitat de Barcelona , Carrer de Villaroel 170, 08036 Catalonia ,","place":["Spain"]},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) , Carrer del Rossell\u00f3, 149, 08036 Barcelona, Calatonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frida","family":"Eulogio-Valenzuela","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular, Hospital Cl\u00ednic, Universitat de Barcelona , Carrer de Villaroel 170, 08036 Catalonia ,","place":["Spain"]},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) , Carrer del Rossell\u00f3, 149, 08036 Barcelona, Calatonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria \u00c1ngeles","family":"Castel","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular, Hospital Cl\u00ednic, Universitat de Barcelona , Carrer de Villaroel 170, 08036 Catalonia ,","place":["Spain"]},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) , Carrer del Rossell\u00f3, 149, 08036 Barcelona, Calatonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1215-3472","authenticated-orcid":false,"given":"Jos\u00e9 Maria","family":"Tolosana","sequence":"additional","affiliation":[{"name":"Institut Cl\u00ednic Cardiovascular, Hospital Cl\u00ednic, Universitat de Barcelona , Carrer de Villaroel 170, 08036 Catalonia ,","place":["Spain"]},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS) , Carrer del Rossell\u00f3, 149, 08036 Barcelona, Calatonia ,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red, Enfermedades Cardiovasculares (CIBERCV) , Av. Monforte de Lemos, 3-5, 28029 Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"2026061819464475500_ytag411-B1","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.13202","article-title":"Sinus node dysfunction after heart transplantation: an analysis of risk factors and atrial pacing burden","volume":"32","author":"Herrmann","year":"2018","journal-title":"Clin Transplant"},{"key":"2026061819464475500_ytag411-B2","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.120.007954","article-title":"Management of arrhythmias after heart transplant: current state and considerations for future research","volume":"14","author":"Joglar","year":"2021","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026061819464475500_ytag411-B3","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/00001573-200003000-00009","article-title":"Cardiac pacemakers in the transplanted heart: short term with the biatrial anastomosis and unnecessary with the bicaval anastomosis","volume":"15","author":"Herre","year":"2000","journal-title":"Curr Opin Cardiol"},{"key":"2026061819464475500_ytag411-B4","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1056\/NEJMoa2300080","article-title":"A dual-chamber leadless pacemaker","volume":"388","author":"Knops","year":"2023","journal-title":"N Engl J Med"},{"key":"2026061819464475500_ytag411-B5","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.hrcr.2023.09.018","article-title":"First reported dual-chamber leadless pacemaker in a patient with orthotopic heart transplant","volume":"9","author":"Kaptein","year":"2023","journal-title":"HeartRhythm Case Rep"},{"key":"2026061819464475500_ytag411-B6","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1016\/j.hrthm.2025.03.1941","article-title":"Dual-chamber leadless pacemaker implant procedural outcomes: Insights from the AVEIR DR i2i study","volume":"22","author":"Doshi","year":"2025","journal-title":"Heart Rhythm"},{"key":"2026061819464475500_ytag411-B7","article-title":"3D computed tomography integration guiding permanent Aveir AR leadless pacemaker implantation: a case report","volume":"9","author":"Magdy","year":"2024","journal-title":"Eur Heart J Case Rep"},{"key":"2026061819464475500_ytag411-B8","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.1016\/j.jacep.2023.05.020","article-title":"Long-term outcomes of permanent pacemaker implantation in bicaval heart transplant recipients","volume":"9","author":"DeFilippis","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"2026061819464475500_ytag411-B9","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur Heart J"},{"key":"2026061819464475500_ytag411-B10","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.hroo.2025.05.011","article-title":"First European experience with a leadless atrial pacemaker","volume":"6","author":"Von Felten","year":"2025","journal-title":"Heart Rhythm O2"}],"container-title":["European Heart Journal - 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