{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:50:39Z","timestamp":1791366639548,"version":"4.3.1"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Electrosurgical facilitation can aid difficult left bundle branch area pacing lead advancement, but standardized delivery patterns, reassessment logic, and follow-up lead performance remain insufficiently defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We retrospectively analyzed 15 consecutive patients undergoing standardized spark-pattern cut-mode electrosurgical bailout after conventional mechanical left bundle branch area pacing lead advancement failed. The generator was operated in unipolar cut-mode at 20 W; spark-pattern delivery denoted brief sliding contact to the exposed cathode segment followed by immediate mechanical readvancement and ECG\/electrogram reassessment. A prestandardization sustain-mode polymorphic ventricular tachycardia\/ventricular fibrillation event outside the 15-patient cohort informed the safety workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Conventional advancement failed in all included patients. Across 50 target-site advancement attempts, spark-pattern cut-mode assistance was activated at 15 final target sites, requiring 1.5\u00b10.6 cycles per patient. Procedural success of left bundle branch area pacing lead deployment was achieved in 15\/15. V1 terminal rightward progression occurred in 14\/15, jump in 14\/15, and split\/discrete components in 12\/15. Spark-associated premature ventricular complexes occurred in 15\/15 but were isolated and self-limited; no nonsustained ventricular tachycardia, sustained ventricular tachycardia, polymorphic ventricular tachycardia\/ventricular fibrillation, defibrillation, or hemodynamic instability occurred during the standardized workflow. Mean follow-up was 400\u00b1170 days; no clinically documented lead malfunction, dislodgement, microdislodgement, loss requiring revision, septal perforation, ventricular septal defect, pericardial effusion, or reintervention occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>A standardized spark-pattern cut-mode bailout workflow provides a reproducible framework for difficult left bundle branch area pacing lead deployment. Progression markers should be distinguished from procedural success, and follow-up surveillance remains essential. Larger studies with longer follow-up and dedicated lead-integrity testing are required before general adoption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.126.015435","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:00:48Z","timestamp":1791363648000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Standardized Spark-Pattern Cut-Mode Electrosurgical Bailout Workflow for Difficult Left Bundle Branch Area Pacing Lead Advancement: Procedural and Follow-Up Outcomes From a 15-Patient Case Series"],"prefix":"10.1161","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4506-6842","authenticated-orcid":true,"given":"Binbin","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1934-5618","authenticated-orcid":true,"given":"Longfu","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5521-7974","authenticated-orcid":true,"given":"Xianfeng","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hengdong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2568-7766","authenticated-orcid":true,"given":"Ding","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1137-8055","authenticated-orcid":true,"given":"Lu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0789-0662","authenticated-orcid":true,"given":"Nan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zixuan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningbo No.2 Hospital, Wenzhou Medical University, China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad044"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac445"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16057"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/pace.14804"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15853"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2024.07.021"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.06.003"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2025.09.045"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2026.03.1943"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2025.04.043"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16128"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2024.05.007"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.126.015435","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:00:49Z","timestamp":1791363649000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.126.015435"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":12,"alternative-id":["10.1161\/CIRCEP.126.015435"],"URL":"https:\/\/doi.org\/10.1161\/circep.126.015435","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"2026-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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