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Normal device readings did not exclude rare structural complications after left bundle pacing

Heart rhythm (PubMed)Aug 23, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A systematic review of case-based evidence grouped rare left bundle branch area pacing complications into five clinical categories and cautioned that normal device parameters do not exclude structural injury.

What NurseJet pulled from the source

Sixty-seven case reports or small case series described septal, vascular, valvular or subvalvular, mechanical or lead-related, and electrophysiologic complications. Presentations included delayed perforation, arrhythmias, thromboembolism, tamponade, vascular injury that mimicked acute coronary syndromes, and other structural problems despite normal electrical measurements.

Why this matters for nurses

Telemetry and cardiac nurses may be first to recognize a new symptom after conduction-system pacing. The review emphasizes combining the patient’s presentation with rhythm, device data, and ordered imaging rather than using normal device measurements as the sole reassurance.

Bedside takeaway

Treat new symptoms after left bundle pacing as clinically meaningful even when device measurements appear normal.

How This Applies in Practice

Use this when: Monitoring a patient after left bundle branch area pacemaker implantation or evaluating a new post-procedure concern.

On your shift

Review the procedure timing, current symptoms, hemodynamics, rhythm, and available device data together.
Report new arrhythmia, instability, ischemia-like symptoms, or neurologic change through the urgent escalation pathway.
Prepare for ordered device interrogation and imaging without treating normal electrical parameters as a structural rule-out.

Keep in mind: Case-based evidence cannot quantify risk. Follow the cardiac team’s plan, facility protocol, and provider orders.

Key takeaways

The review synthesized 67 case reports or small case series rather than comparative trials.
Complications fell into septal, vascular, valvular or subvalvular, mechanical or lead-related, and electrophysiologic categories.
Delayed perforation could present with arrhythmia, thromboembolism, or tamponade.
Normal electrical device parameters did not rule out clinically important structural complications.

Practice implications

After left bundle branch area pacing, connect new hemodynamic change, arrhythmia, ischemia-like symptoms, or neurologic concern with the recent procedure and escalate promptly. Continue ordered rhythm and device monitoring while the team evaluates for structural as well as electrical causes.

Limitations & cautions

The evidence consists of case reports and small case series, which cannot estimate complication incidence or compare management strategies. Publication bias likely favors unusual or severe events.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Heart rhythm (PubMed)

Heart rhythm (PubMed). Rare Complications of Left Bundle Branch Area Pacing: A Systematic Review of Case-Based Evidence.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42633831/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Clinical research in cardiology : official journal of the German Cardiac Society (PubMed)Sep 28, 2026Research Article

A prespecified sex-specific secondary analysis of the PUSH-AHF trial in 310 patients found natriuresis-guided diuretic therapy increased 24-hour sodium excretion and reduced 180-day mortality or heart failure readmission in men, but not in women.

Telemetry ICUAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Natriuresis-guided loop diuretic titration uses spot urinary sodium measurements to tailor decongestive therapy in acute heart failure (AHF). In this sex-specific analysis of the randomized PUSH-AHF trial, investigators evaluated 310 patients (45% women) assigned to natriuresis-guided therapy versus standard of care. In men, natriuresis-guided therapy produced significantly greater mean 24-hour total natriuresis compared with standard care (443 vs 354 mmol, p = 0.004), whereas women showed no significant difference between treatment arms (357 vs 336 mmol, p = 0.533; adjusted p-interaction = 0.276). Notably, the median 24-hour natriuretic response per milligram of loop diuretic (bumetanide equivalents) was significantly lower in women receiving natriuresis-guided therapy than standard care (23 vs 52 mmol/mg, p = 0.001), while no difference was observed in men (38 vs 45 mmol/mg, p = 0.337; adjusted p-interaction = 0.009). Clinically, natriuresis guidance was associated with a 49% lower risk of 180-day all-cause mortality or HF rehospitalization in men (adjusted HR 0.51; 95% CI, 0.30–0.86; p = 0.011), but showed no benefit in women (adjusted HR 1.40; 95% CI, 0.67–2.91; p = 0.368; adjusted p-interaction = 0.026).

Key takeaways

Sex-specific analysis of the PUSH-AHF randomized trial evaluated 310 patients (45% women) with acute heart failure.
In men, natriuresis-guided therapy increased 24-hour urinary sodium excretion (443 vs 354 mmol, p = 0.004) and reduced 180-day mortality/rehospitalization by 49% (adjusted HR 0.51, p = 0.011).
In women, natriuresis guidance did not increase total natriuresis (357 vs 336 mmol, p = 0.533) or improve 180-day clinical outcomes (adjusted HR 1.40, p = 0.368; p-interaction = 0.026).
Women in the guided arm exhibited a blunted natriuretic response per milligram of loop diuretic (23 vs 52 mmol/mg bumetanide, p = 0.001).

Why this matters on shift

Cardiology and telemetry nurses frequently manage intensive loop diuretic infusions and collect spot urinary sodium samples during acute decompensated heart failure admissions. These findings demonstrate that diuretic responsiveness and natriuresis-guided protocols may operate differently by biological sex, warning clinicians that intensifying diuretic doses based solely on spot sodium targets may not yield uniform decongestive or prognostic benefits across all patient groups.

Bedside takeaway

In the PUSH-AHF trial (310 patients), natriuresis-guided diuretic therapy reduced 180-day mortality/readmission in men (aHR 0.51) but showed no benefit in women (aHR 1.40; p-interaction=0.026).

Nursing implications

Collect urine samples for spot sodium strictly at ordered intervals during acute decongestion, maintain accurate intake/output records, monitor serum electrolytes and renal function closely during diuretic uptitration, and recognize that blunted urinary sodium output in female patients may reflect altered pharmacodynamics rather than simple noncompliance with fluid restrictions.

Limitations & cautions

Post-hoc subgroup analysis of a randomized trial with limited sample size (n = 310, including 139 women); findings are hypothesis-generating and require prospective validation in sex-stratified clinical trials before modifying clinical guidelines.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Clinical research in cardiology : official journal of the German Cardiac Society (PubMed). Effects of natriuresis-guided diuretic therapy in men and women with acute heart failure: insights from PUSH-AHF.

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AI-summarized from the linked source. Review the original article before applying to practice.

JAMA (PubMed)Oct 13, 2026Research Article

In a multicenter phase 3 trial of 989 actively bleeding cardiac surgery patients undergoing cardiopulmonary bypass, cold-stored platelets preserved up to 21 days met noninferiority criteria compared to standard 7-day room-temperature platelets for hemostatic control and 24-hour chest tube drainage.

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Research ArticleResearchQuality ImprovementWorkflowAI summary · original source linked below

Platelet shortages and brief 5- to 7-day room-temperature storage limits frequently challenge hospital blood supplies and acute perioperative transfusion support. The phase 3 CHIPS trial was a multicenter, randomized, partially blinded, adaptive noninferiority trial conducted across 27 hospitals in the United States and Australia. The trial evaluated whether cold-stored platelets (CSPs; 1–6 °C, stored up to 21 days) were noninferior to standard room-temperature platelets (RTPs; 20–24 °C, stored up to 7 days) in patients with active surgical bleeding during or after cardiac surgery with cardiopulmonary bypass. Among 1,000 patients randomized 2:1 and 989 included in the primary analysis (650 CSPs, 339 RTPs; mean age 42.1 years; 67.8% male), CSPs were noninferior to RTPs for the primary 5-point hemostatic efficacy score across all storage durations (>99.9% posterior probability of noninferiority; pooled mean difference 0.09; 95% credible interval -0.06 to 0.23). Median 24-hour chest tube output was similar between groups (8.9 mL/kg for CSPs vs 8.4 mL/kg for RTPs; difference 0.4 mL/kg; 95% CI -1.0 to 1.5). Rates of arterial and venous thrombotic events, ARDS, acute kidney injury, septic shock, and mortality showed no significant differences, although surgical reexploration was higher in the CSP cohort.

Key takeaways

Phase 3 adaptive trial across 27 centers in the US and Australia randomized 1,000 cardiac surgery patients with active surgical bleeding.
Cold-stored platelets preserved up to 21 days demonstrated noninferior hemostatic efficacy compared to room-temperature platelets (>99.9% probability).
Twenty-four-hour chest tube drainage showed no significant difference between cold and room-temperature platelets (8.9 vs 8.4 mL/kg).
Adverse safety endpoints including thrombosis, septic shock, and mortality were comparable, with higher surgical reexploration noted in the cold-stored group.

Why this matters on shift

Cardiac and critical care nurses routinely infuse platelets to control coagulopathic bleeding after cardiopulmonary bypass and closely monitor postoperative mediastinal drain outputs. Extending platelet shelf life from 7 to 21 days through cold storage could dramatically reduce product waste and eliminate critical shortages during emergency surgical resuscitation.

Bedside takeaway

In a 989-patient trial of bleeding cardiac surgery patients, cold-stored platelets up to 21 days were noninferior to standard room-temperature platelets for hemostasis (mean diff 0.09), with similar 24-hr chest tube drainage (8.9 vs 8.4 mL/kg).

Nursing implications

Monitor post-bypass chest tube drainage volumes hourly, confirm platelet storage temperature and expiration integrity before transfusion, and remain vigilant for signs of active postoperative hemorrhage and indications for surgical reexploration.

Limitations & cautions

Partially blinded trial design; single-product evaluation focused strictly on cardiopulmonary bypass surgery; increased reexploration rate in the cold-stored group warrants careful clinical surveillance.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

JAMA (PubMed). Cold and Room-Temperature Platelets in Cardiac Surgery: The CHIPS Randomized Clinical Trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

The Lancet regional health. Europe (PubMed)Aug 30, 2026Research Article

The 6-country AFFIRMO cluster-randomized trial of 1,260 older multimorbid atrial fibrillation patients found that adding a mobile health integrated care and comprehensive geriatric assessment system did not decrease unplanned hospitalizations (17.1% vs 18.2%) in a population already exhibiting 97.3% baseline guideline adherence.

Telemetry GeriatricsAI summaryReview source

Research ArticleResearchQuality ImprovementWorkflowAI summary · original source linked below

Older patients with atrial fibrillation frequently present with complex multimorbidity and polypharmacy, driving hospitalizations and adverse cardiovascular events. The AFFIRMO trial, an open-label cluster-randomized study conducted across clinical centers in six European countries, evaluated whether an integrated care system (iABC) combining mobile health tracking with comprehensive geriatric assessment reduced clinical outcomes compared to guideline-based usual care. The trial enrolled 1,260 patients (mean age 74 years; 44.4% female; median CHA2DS2-VASc score 4; 41.0% with >2 comorbidities) across allocated clusters (634 intervention, 626 usual care). Baseline guideline adherence was exceptionally high, with 97.3% (1,226/1,260) already receiving oral anticoagulation. Over follow-up, the primary endpoint of all-cause unplanned hospitalization occurred in 108 (17.1%) intervention patients and 114 (18.2%) usual care patients (adjusted OR 0.95; 95% CI 0.61 to 1.49; P = 0.84). Digital app engagement was low, with 68.5% of intervention participants utilizing the mobile platform for only one-third of the study duration.

Key takeaways

Multicenter cluster-randomized trial enrolled 1,260 older adults with atrial fibrillation and multiple chronic conditions across six European nations.
Baseline anticoagulation adherence was exceptionally high at 97.3%, and comprehensive geriatric assessment revealed high baseline functional independence.
Unplanned hospitalizations did not differ significantly between the mHealth integrated care group and usual guideline care (17.1% vs 18.2%, P = 0.84).
Digital intervention engagement was suboptimal, with over two-thirds of older participants actively using the mobile app for only one-third of follow-up.

Why this matters on shift

Cardiovascular and telemetry nurses frequently coordinate discharge teaching and digital health tools for older adults with arrhythmias. This robust trial demonstrates that digital health platforms yield no measurable clinical benefit when foundational guideline care is already high, and underscores that tech-dependent solutions must address real-world usability challenges among older adults.

Bedside takeaway

In the 1,260-patient AFFIRMO trial of older multimorbid AF patients with 97% baseline anticoagulation, adding mHealth-guided care did not lower unplanned hospitalizations (17.1% vs 18.2%), constrained by low app adoption.

Nursing implications

Emphasize reliable adherence to evidence-based oral anticoagulation and rhythm/rate medications during cardiac nursing discharge education, rather than relying on unproven digital health apps, and directly assess older patients for device usability and digital literacy before recommending mobile tracking.

Limitations & cautions

Open-label cluster design; baseline guideline adherence was extraordinarily high (97.3%), creating an event floor; suboptimal patient adoption of the smartphone application limited potential intervention impact.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

The Lancet regional health. Europe (PubMed). Integrated care management and comprehensive geriatric assessment using a mHealth-based approach in older multimorbid patients with atrial fibrillation: the AFFIRMO cluster-randomised trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

PUSH-AHF trial analysis finds natriuresis-guided diuretic therapy reduces 180-day events in men but not women with acute heart failure

CHIPS randomized trial finds cold-stored platelets up to 21 days noninferior to room-temperature platelets for bleeding in cardiac surgery

AFFIRMO cluster trial finds mHealth and geriatric assessment did not reduce hospitalizations in older atrial fibrillation patients already receiving guideline care