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Pacing Type Matters, Abbott’s PVL Plug, and AI Slides
By Viktor Zarev, Virginia Hunt
October 29, 2026
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Together with
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“There is only one thing worse than reading from your slides; That is reading from AI generated slides.”
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C. Michael Gibson, MD
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As we head to TCT 2026 this weekend, I’m always reminded by the sheer complexity of interventional cardiology and the cath lab. That’s why I found my interview with Dr. Issam Moussa and Dr. Sanjay Mehta particularly exciting as they walked me through how Canon’s ɑEvolve software is helping change the way they make interventional decisions. You can watch it here.
And as you know, I’m a big fan of clinical decision-making studies, which today’s top story is one of.
Thanks for reading and see ya at TCT!
Cheers,
Vik
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Right ventricular pacing (RVP) is the default for patients with AV block and normal LV function, because it’s simple, reliable, and guideline-backed. But a new randomized trial in JAMA suggests left bundle branch area pacing (LBBAP) is the better call, even in this lower-risk group.
- RVP remains widely used in AV block patients, but since it uses the heart muscle cells to deliver pacing, it’s linked to higher risks of HF, AFib, and mortality.
- Studies like BLOCK-HF suggest biventricular pacing is better than RVP when LVEF is reduced, but that benefit hasn’t been shown with preserved LVEF.
- Furthermore, LBBAP trials (like LBBP-FAVOR, PACE-HF, CSPACE) were small and enrolled higher-risk patients, so current guidelines still favor RVP when LV function is normal.
Enter LEAP-Block to settle the score using a superiority trial design that randomized 499 AVB patients across China to LBBAP or RVP, with a primary composite endpoint of all-cause death, HF events, or upgrade to biventricular pacing 24 months post implant.
- Notably, patients started with an average LVEF of 64% (quite normal), and 54.6% had complete AV block.
- All patients received a dual-chamber pacemaker for direct comparison between the pacing methods.
After 24 months, the headline result was hard to miss. Patients who received LBBAP were much less likely to experience the composite end point of death, HF, or upgrade.
- Specifically, these events occurred in 2.4% of LBBAP patients vs. 12.5% of RVP patients.
- That benefit held across all of the study’s prespecified subgroups like sex, baseline QRS duration, and underlying cardiac disease.
- Procedural success was also very similar (97.9% vs. 99.6%), though LBBAP lead placement took a bit longer (12 vs. 7 minutes).
Looking under the data’s hood tells us where the real advantage is and nearly all of the benefit comes from fewer HF events (LBBAP: 3.4% vs. RVP: 11.3%).
- Thus, there were no statistically significant differences in the other separate outcomes like death, BiV upgrades, device complications, or pacing-induced cardiomyopathy.
The Takeaway
LBBAP’s success has already outpaced (pun intended) the smaller study evidence backing it, and LEAP-Block now gives even stronger randomized support for its use in lower-risk AV block patients. Add in the confirmed HF payoff and the “RVP by default” guidelines seem due for a change.
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Canon’s 30 Years of Caring
For over 30 years, Canon has helped advance pediatric interventional cardiology through innovation and a commitment to better care. Learn more about how and why modern pediatric cardiac angiography came to be from one of its founding members, Dr. John P. Cheatham.
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State-of-the-Art Cardiac Monitoring at Scale
Cleared for 13 different heart rhythm interpretations, AccurKardia’s AccurECG 2.0 shortens the time from an arrhythmia incident to clinical intervention. Watch here to find out how AccurKardia and Specialized Medical are teaming up to bring the AccurECG 2.0 technology to clinicians across the U.S.
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- Post-TEER Recurrent MR Risks: Residual MR after TEER is well known to be associated with worse outcomes, but what are the risks when MR comes back after a successful procedure? Among 461 MR patients who underwent successful M-TEER, four-year all-cause mortality occurred in 56.3% of patients who developed recurrent MR and 44.8% of those who didn’t. That gap corresponded to a 43% higher mortality risk for patients with recurrent MR. Importantly, survival differences were only significant in patients with degenerative MR, not those with functional MR.
- Women’s Heart Health Framework: CV risk varies across someone’s lifetime, and, for women, much of this development is linked to hormonal fluctuations, including those caused by birth control or other therapies. A three-manuscript framework from the AHA and a trio of women’s health organizations outlines unique risk-prevention strategies for each life stage, ranging from menstrual initiation to post-menopause. The framework highlights how irregular periods and conditions like polyendocrine metabolic ovarian syndrome can serve as very early markers of risk. Pregnancy and postpartum stages are also emphasized as crucial to CV health.
- Postpartum BP Connected to CVD: Speaking of important life-stage risk factors for women, irregular postpartum BP might have long-term consequences for CVD risk. Among 39.9k women with hypertensive disorders of pregnancy who gave birth between ages 15-49 years, CVD events occurred in 3% of women. Surprisingly, the vast majority (68%) of cases occurred in women <40 years old, which may be explained in part by preeclampsia, gestational hypertension, and elevated BP at six-weeks postpartum. These conditions were linked to 2x, 1.97x, and 1.96x higher respective risks of developing CVD.
- Medtronic Recalls Defibrillator Leads: Medtech giant Medtronic is recalling 717 units of its OmniaSecure defibrillation lead due to heightened risks of unsuccessful implantation and tissue trauma. The company noted that the issue was discovered via an internal quality check, and no adverse events related to the affected leads have been reported. Still, Medtronic advised their customers to separate and return the devices for an engineering evaluation. Importantly, the recall and associated risks do not affect devices which have been implanted successfully.
- TruLeaf’s RoseDoc Treats First Two: Budding structural heart devicemaker TruLeaf Medical completed the first stage of its RoseDoc TTVR implants in two patients in Uzbekistan. Using a minimally invasive catheter, researchers successfully completed the first phase of TruLeaf’s replacement procedure by placing the RoseDoc’s dock in two patients with massive tricuspid regurgitation. The replacement valve goes into the dock in a second percutaneous procedure later to ensure the anchoring on the tricuspid valve is as secure as possible for long-term outcomes.
- Abbott Plugs the PVL Gap: In other structural heart news, Abbott earned FDA approval for the Amplatzer Paraclose PVL Occluder, making it the first transcatheter device in the U.S. for closing paravalvular leaks around surgical valves. Currently, paravalvular leaks occur in 7–17% of mitral and 5–10% of aortic replacements, with repeat open-heart surgery being the only approved fix until now. Side note – this is old news for our readers in Europe, where Paraclose has been approved as the Amplatzer Valvular Plug III since 2020.
- Hidden Inflammation in Low-Risk Hearts: Normal bloodwork and a clean coronary CT might not tell a patient’s whole story. A new preventive clinic study in the U.S. evaluated Caristo’s AI-powered CaRi-Heart in asymptomatic, low-risk patients and found elevated coronary inflammation in 42.9% of them. In fact, 17.9% of patients’ inflammation was “very high” in at least one major artery. Meanwhile, about 47% of patients with no detectable plaque still showed inflammation. One caveat though, this data is from a company-run study, and the prognostic value is unproven.
- Legal Weed, Busier Cardiac Wards: Does legal cannabis come with a public heart health bill? To answer this, researchers conducted a difference-in-differences analysis of the National Inpatient Sample comparing the Western U.S., where recreational sales began in 2014, against regions that waited until late 2018. Each year of legalization was tied to 3.7% more HF hospitalizations, 3.1% more MI, and 2.3% more AFib per capita. However, the study’s observational design can’t prove legalizing cannabis caused the uptick.
- A CPT Code for AI Heart Attack Detection: AI-detected heart attacks now have their very own CPT code. The AMA created a Category III code (1139T) for algorithmic ECG detection of STEMI, STEMI equivalents, and acute ischemia. The code takes effect January 1, 2027, and is reported alongside standard 12-lead ECG codes. This CPT code follows the FDA’s de novo clearance of Powerful Medical’s Queen of Hearts STEMI detecting AI. A code isn’t payment, though, and Powerful Medical will still need CMS reimbursement to thrive in the U.S.
- Monebo’s ECG Library Gets Cleared: Staying on ECG software, Monebo scored FDA 510(k) clearance for its Kinetic Software Library, an ECG analysis platform that device makers can drop into their products through a cross-platform API. It handles QRS and ectopic beat detection, feature extraction, heart rate, and rhythm analysis. Monebo has been in the space since 2002, and 51 later clearances trace their predicate lineage back to its earlier libraries. The pitch is that device makers get a cleared starting point instead of rebuilding arrhythmia analysis themselves.
- Are You Tired of AI Slides? Cardiologists have a new conference pet-peeve: AI-generated slides. Per a TCTMD interview, NYU’s Sripal Bangalore described “AI fatigue” from speakers whose decks look identical, and ACC President Roxana Mehran said she tunes out the moment she spots them. Others flagged hallucinated content, garbled figure text, and guideline recommendations conflated across societies. Stanford’s Mintu Turakhia suggested dropping slides from some sessions entirely. Nobody’s calling for an AI ban, but it’s clear that overusing it leads to sloppy presentations.
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HFSA Late-Breaker Findings
New research presented as a Late Breaker at HFSA demonstrated that patients receiving CCM® Therapy experienced significant long-term improvements in heart failure hospitalization rates and other key measures of cardiac health, including NT-proBNP, functional status, quality of life, and diuretic use… Read More.
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The Benefits of Outsourced Post-Processing
Using an outsourced cardiac image post-processing solution doesn’t have to mean sacrificing control of the results. Discover how PIA’s customizable post-processing workflow can help you get the most out of your images.
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- VASCADE MVP® XL Vascular Closure System: Sometimes EP procedures call for a venous vascular closure system that is simply bigger. Haemonetics’ VASCADE MVP XL closure system comes with 58% more collagen and a 9% larger disc compared to the VASCADE MVP system as well as an expanded indication for utilizing 10-14F inner diameter sheaths.
- A Rad’s Eye View: AI-enabled post-processing software dramatically reduces cardiac imaging analysis times while improving consistency and collaboration between radiologists and cardiologists. Hear from Laura Dragonetti, MD on how detailed CMR quantification enabled by Circle Cardiovascular Imaging detects disease much earlier.
- The Benefits of Cardiovascular Structured Reporting: Cardiovascular imaging’s growing demand means providers need structured reporting to manage their clinical workflows. Discover why Optum’s structured reports allow for more automated EHR and modality data while helping standardize clinical workflows.
- ALL‑RISE Trial Results Are In: The CathWorks FFRangio™ system met noninferiority to wire-based physiology for MACE at one year with statistically significant improvement in resource utilization and reduced procedure time. CathWorks FFRangio™ system is the new standard in coronary physiology. See the ALL-RISE data. The information provided by the CathWorks FFRangio™ system is intended to be used by a qualified clinician in conjunction with the patient’s clinical history, symptoms, and other diagnostic tests, as well as the clinician’s professional evaluation. Source: Fearon et al. NEJM 2026. doi: 10.1056/NEJMoa2600949
- A Cardiovascular Ultrasound Platform You Can Trust: Being able to provide premium diagnostic information for your pediatric patients every day, all day, is vital. Find out why cardiac imagers trust Fujifilm’s Lisendo 880, and how its premium imaging quality, efficiency tools, and reliability you can trust, have helped change workflows for clinicians and technologists alike.
- How AI Expands the Role of CMR Experts: If you’re an MRI technologist, AI could be the best thing that ever happened to your career. Read here to learn about the benefits of AI for CMR experts and how it can accelerate both your training and career.
- Circadian Rhythms Revolutionize Cardiac Monitoring: Understanding a patient’s natural circadian rhythms can reveal deeper insights during cardiac monitoring. Find out how Monebo’s monitoring approach provides a visual representation of heart rate, cardiac muscle relaxation, and QT-RR throughout the circadian cycle.
- Integrating AI for Enhanced Echo: Sometimes it pays dividends to be an early adopter. Find out how the Christ Hospital’s early evaluation of Merge Cardio 12.5 allowed for remote echocardiography measurements, enhanced reporting accuracy, and a seamless user experience, bringing even greater efficiencies and clinical confidence.
- Corbotics and Us2.ai’s End-to-End Automated Echo: There’s a growing demand for cardiac imaging in the face of sonographer shortages and increasing pressure on specialist resources. That’s why Us2.ai and Corbotics are combining autonomous robotic echo acquisition with AI-powered analysis to create an end-to-end automated echocardiography workflow.
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