Pacemakers are cardiac implantable electronic devices (CIEDs) that deliver electrical impulses to regulate heart rhythm and manage conditions such as cardiac arrhythmias. While transvenous pacemakers (TP) have a generator with pacing leads, leadless pacemakers (LPs) are anchored within the right ventricular endocardium via tined or helical fixation. Device extractions may occur due to infection, dysfunction, or device upgrade. This study aims to analyze the incidence and severity of extraction complications between TPs and LPs. A comprehensive narrative review was performed through the PubMed database. The following key search terms and synonyms were incorporated into the search algorithm: “transvenous pacemaker,” “leadless pacemaker,” “pacemaker extraction,” “device infection,” and “bacterial complications”. This yielded 788 entries. After uploading the search results, articles that focused on pacemaker extractions were included, while animal studies, pediatric studies, and studies that were not peer-reviewed were excluded. After excluding 691 studies, 97 original articles on pacemaker extractions underwent full-text analysis. Both TP and LP extractions had high procedural success and low mortality rates. TPs were found to have procedural risks absent from leadless, namely, the development of arteriovenous fistula through subclavian access, tricuspid dysfunction, and atrial tearing. Examples of some differences between these studies include one LP study, which reported no change in mortality at a follow-up period of 18 months, and one TP study showed little change in mortality up to 24 months. Patients with TP and bacteremia have an increased risk of infection in the pocket and along the pacing leads. Infection of pacing leads has been shown to increase mortality and long-term complications. LPs are favored in many cases, for they minimize the incidence of these complications, have shorter extraction times, and have better recovery post-op in comparison to TPs. LPs are associated with fewer extraction complications due to their smaller size and minimally invasive procedural approach, eliminating the use of a generator pocket and transvenous leads. Due to the incorporation of case studies, this review’s limited sample size may decrease external validity. Future studies should collect large-scale data to further analyze the extraction complications between TP and LP patients.

Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure in which the ejection fraction remains within the normal range (≥50%); however, patients still experience typical symptoms of heart failure. One of the most common manifestations in this population is exercise intolerance, which in some cases may be the only presenting symptom. Exercise intolerance refers to a reduced capacity to perform physical activity. Several processes, including impaired cGMP–PKG signaling, increased collagen deposition, endothelial dysfunction, increased arterial stiffness, pulmonary hypertension, and vascular remodeling, contribute to the pathophysiology of HFpEF. The disruption of these fundamental physiological processes significantly impairs exercise capacity, leading to attenuated increases in heart rate, stroke volume, and/or contractility, along with abnormal ventricular–vascular coupling during exertion. When EI is suspected, a spectrum of diagnostic modalities—from simple, low-cost tools such as the 6 min walk test to advanced imaging—can be used to evaluate its presence and its association with HFpEF. When EI in HFpEF is diagnosed, management should focus on addressing this limitation to improve quality of life and reduce morbidity and mortality. Exercise training and pharmacological therapies, such as SGLT2 inhibitors, may be beneficial in this population. In conclusion, EI is a common manifestation of HFpEF that significantly impacts patients’ quality of life. Understanding its underlying mechanisms and addressing it appropriately are essential to improving patient outcomes.

Scimitar syndrome is a rare congenital form of partial anomalous pulmonary venous return characterized by right pulmonary venous drainage into the inferior vena cava, causing right-sided volume overload and increased risk of supraventricular arrhythmias, particularly in adolescents and adults. However, existing studies do not clearly describe reported arrhythmia patterns or how heart rhythm changes over time. This structured literature review aimed to characterize the reported atrial and supraventricular arrhythmias and conduction disturbances in patients with Scimitar syndrome and examine their relationship with atrial remodeling, hemodynamic burden, associated structural abnormalities, and surgical or catheter-based intervention. PubMed, Embase, Web of Science, and the Cochrane Library were searched from September 2026. Of 308 abstracts, 42 articles met the inclusion criteria (Scimitar syndrome patients, with broader PAPVR populations included as contextual evidence; literature reviews, abstract only publications, animal studies and non-English articles were excluded). Studies consistently showed that Scimitar syndrome is associated with right-sided volume overload linked to increased atrial and supraventricular arrhythmias, most commonly atrial fibrillation and flutter, with greater risk in patients with associated atrial septal defects or pulmonary hypertension. Because Scimitar syndrome can remain undiagnosed until adulthood, future studies should identify specific predictors of arrhythmia development to improve long-term electrophysiological outcomes.

Introduction: Scimitar syndrome is a rare congenital form of partial anomalous pulmonary venous return characterized by right pulmonary venous drainage into the inferior vena cava. This abnormal shunting leads to right sided volume overload and increased risk of supraventricular arrhythmias, particularly in adolescents and adults. However, existing studies do not clearly describe reported arrhythmia patterns or how heart rhythm changes over time. Objectives: This systematic review aims to describe how congenital cardiopulmonary abnormalities in patients with Scimitar syndrome contribute to atrial remodeling and the development of atrial and supraventricular arrhythmias. Methods A literature review search was conducted in PubMed. Relevant data were extracted after screening titles, 308 abstracts were assessed using inclusion and exclusion criteria. Full text screening was performed for 94 articles, Inclusion criteria consisted of patients with Scimitar syndrome. Exclusion criteria included literature review, animal studies and non-English articles. Results: Studies consistently showed that Scimitar syndrome is associated with right atrial enlargement and atrial remodeling due to chronic right-sided volume overload. These changes were linked to an increased burden of atrial and supraventricular arrhythmias, most commonly atrial fibrillation and atrial flutter. Arrhythmia risk was greater in patients with associated abnormalities such as atrial septal defects or pulmonary hypertension. Discussion and Conclusion: Scimitar syndrome often presents with atrial remodeling and cardiac abnormalities that increase the risk of arrhythmias, especially atrial fibrillation and atrial flutter. Given that scimitar syndrome can remain undiagnosed until adulthood, future studies should focus on the specific predictors for arrhythmia development to improve long-term electrophysiological outcomes.