Pocket hematoma is a common complication following cardiac implantable electronic device (CIED) implantation, traditionally perceived as a manageable local issue. Accumulating evidence, however, indicates that clinically significant pocket hematoma (CSH) is strongly associated with increased infection rates, elevated healthcare costs, and heightened mortality. Key risk factors include advanced age, low body mass index (BMI), chronic kidney disease, complex procedures (device upgrades/replacements) and periprocedural antithrombotic management, particularly uninterrupted dual antiplatelet therapy (DAPT) and heparin/low-molecular-weight heparin (LMWH) bridging strategies, which significantly elevate bleeding risk compared to continued vitamin K antagonist (VKA) therapy or direct oral anticoagulant (DOAC) protocols. Novel compression devices and topical hemostatic agents show promise for prevention, while standardized definitions and risk stratification tools are urgently needed. This review synthesizes current evidence on multifactorial pathogenesis, adverse outcomes, and evolving preventive strategies for pocket hematoma, emphasizing its underappreciated clinical significance and the critical need for optimized periprocedural management in high-risk patients.

Few studies have considered psychosocial characteristics when investigating the associations between sleep duration and blood pressure (BP). In this study, we took propensity score matching (PSM) to adjust for psychosocial characteristics when comparing BP between individuals with short sleep duration and those with normal sleep duration. A total of 429 participants were included. 72 participants with sleep duration ≤6 h and 65 participants with sleep duration >6 h were matched after PSM. We compared office BP, 24-hour BP, and prevalence of hypertension in the populations before and after PSM, respectively. In the unmatched population, participants with sleep duration ≤6 h were observed with higher office diastolic BP (DBP) and 24-h systolic BP (SBP)/DBP (all ). In the matched populations, the differences between the two groups (sleep duration ≤6 h vs. sleep duration >6 h) in office DBP (88.4 ± 10.9 vs. 82.5 ± 11.1 mm Hg; ), 24-h SBP (134.7 ± 12.0 vs. 129.3 ± 11.6 mm Hg; ), and 24-h DBP (83.4 ± 9.9 vs. 78.1 ± 10.1 mm Hg; ) become more significant. Participants with sleep duration ≤6 h only show higher prevalence of hypertension based on 24-h BP data, while analysis after PSM further revealed that these with sleep duration ≤6 h presented about 20% higher prevalence of elevated BP up to office diagnosed hypertension threshold. Therefore, psychosocial characteristics accompanied with short sleep duration should be fully valued in individuals at risks for elevated BP. This trial is registered with NCT03866226.