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Introduction: Data on implants of cardiac pacing systems in Spain in 2023 are presented., Methods: The registry is based on the information provided by centers to the recording platform of the Heart Rhythm Association after device implantations, through Cardiodispositivos, the online platform of the National Registry. Other information sources include: a) data transfers from the manufacturing and marketing industry; b) the European pacemaker patient card; and c) local databases submitted by the implanting centers., Results: In 2023, 112 hospitals participated in the registry (30 more than in 2022). A total of 24 343 device implantations were reported (48.1% more than in 2022) compared with 45 120 reported by Eucomed (European Confederation of Medical Suppliers Associations). Of these, 1646 were cardiac resynchronization therapy pacemakers. The devices showing the largest increases were leadless pacemakers, with 963 devices implanted, representing an 18.1% increase over 2022. The most frequent indication was atrioventricular block followed, for the first time, by atrial tachyarrhythmia with slow ventricular response. The number of devices included in remote monitoring also increased (cardiac resynchronization therapy defibrillators, 71%; cardiac resynchronization therapy pacemakers, 63%; and conventional pacemakers, 28%), although more moderately., Conclusions: In 2023, there was an increase in the number of institutions participating in the registry. The reporting of device implantations rose by 48.1%, and the implantation of leadless pacemakers grew by 18.1%. Remote monitoring also experienced modest growth compared with previous years., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: This report describes the result of the analysis of the implanted pacemakers reported to the Spanish Pacemaker Registry in 2018., Methods: The analysis is based on the information provided by the European Pacemaker Identification Card and supplier-reported data on the overall number of implanted pacemakers., Results: Information was received from 90 hospitals, with a total of 12 148 cards, representing 31% of the estimated activity. Use of conventional and resynchronization pacemakers was 825 and 77 units per million people, respectively. The mean age of the patients receiving an implant was 78.3 years, and 54% of the devices were implanted in people aged> 80 years. A total of 77.1% were first implants and 21.6% corresponded to generator exchanges. Bicameral sequential pacing was the most frequent pacing mode but was less frequently used in patients aged> 80 years and in women. Single chamber VVI/R pacing was used in 28% of patients with sick sinus syndrome and in 24.7% of those with atrioventricular block, despite being in sinus rhythm., Conclusions: The total consumption of pacemaker generators in Spain increased by 1.2% compared with 2017, mainly due to an 8.7% increase in cardiac resynchronization therapy with pacemaker generators. Selection of pacing mode was directly influenced by age and sex., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Cardiac amyloidosis is an infiltrative disorder caused by extracellular protein deposition. Transthyretin is a proamyloidotic protein that produces one of the most frequent forms of cardiac amyloidosis, either through mutations or a wild-type form (previously known as senile amyloidosis). Until very recently, diagnosis of transthyretin amyloidosis (ATTR) was very uncommon and histological confirmation was mandatory, making diagnosis of ATTR a real challenge in daily clinical practice. Moreover, the specific therapeutic options to alter the clinical course of the disease were very limited. However, advances in cardiac imaging and diagnostic strategies have improved recognition of ATTR. In addition, several compounds able to modify the natural history of the disease are in the final phases of research, with promising results. Given that effective therapies are on the horizon, cardiologists should be well-versed in this disease and be familiar with its diagnosis and treatment. This review describes the broad clinical spectrum of ATTR in detail, as well as recent advances in the diagnosis and treatment of this condition., (Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: There are scarce clinical outcomes data on the new generation recapturable and repositionable CoreValve Evolut R., Methods: Data on all-comer patients undergoing transcatheter aortic valve implantation (TAVI) with the Evolut R for severe symptomatic aortic stenosis at a single center were prospectively collected between February 2015 and April 2016. Clinical endpoints were independently adjudicated according to the Valve Academic Research Consortium-2 criteria. Primary outcomes consisted of early safety composite endpoints and 30-day device success. The incidence of new permanent pacemaker implantation was recorded., Results: Among the 83 patients undergoing TAVI during this period, 71 (85.5% of the population; median age, 83.0 [interquartile range, 80.0-87.0] years; Society of Thoracic Surgeons scores, 4.8±3.5%) were suitable for Evolut R implantation and were included in the analysis. Repositioning was performed in 26.8% of the procedures. The early safety composite endpoint was observed in 11.3% of patients at 30 days, with 2.8% all-cause mortality. Device success was documented in 90.1% of patients. Paravalvular leakage was less than grade II in 98.4% of patients. The mean transvalvular aortic gradient was reduced from 42.5±14.5mmHg at baseline to 7.7±4.0mmHg at discharge (P<.0001 vs baseline). New permanent pacemaker implantation was required in 23.9% of patients., Conclusions: The new generation Evolut R is suitable for most patients and shows high device success and acceptable mortality in an unbiased, consecutive, all-comer population at a single center performing TAVI exclusively with Medtronic valves., (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: We describe the results of the analysis of the devices implanted and conveyed to the Spanish Pacemaker Registry in 2015., Methods: The report is based on the processing of information provided by the European Pacemaker Patient Identification Card., Results: We received information from 111 hospitals, with a total of 12 555 cards, representing 32.1% of all the estimated activity. The use of conventional generators and resynchronization devices was 820 and 73 units per million population, respectively. The mean age of the patients receiving an implantation was 77.7 years, and more than 50% of the devices were implanted in patients over 80 years of age. Overall, 58.6% of the implants and 58.8% of the replacements were performed in men. All of the endocardial leads employed were bipolar, 81.5% had an active fixation system, and 16.5% were compatible with magnetic resonance. Although dual chamber sequential pacing continues to be more widespread, pacing with VVI/R mode is used because up to 23.8% of the patients with sinus node disease are in sinus rhythm, as are 24.1% of those with atrioventricular block., Conclusions: The total use of pacemaker generators in Spain has increased by about 5% with respect to 2014. The majority of the leads implanted are of active fixation, and less than 20% are protected from magnetic resonance. The factors directly related to the selection of pacing mode are age and sex. In around 20% of patients, the choice of the pacing mode could be improved., (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Public administrations have to procure equitable care that compensates resistance factors such as communication problems and those arising from aging. Our objective was to analyze the influence of population dispersion and aging on the frequency rate of some common surgical procedures in elderly patients., Patients and Methods: We used the database of surgical activity of the only hospital in a Spanish province to identify cataract surgeries, hip replacements and pacemaker implants performed during 2010. Using the National Statistics Institute Census, we calculated the rate for each procedure and the proportion of inhabitants over 65 in each municipality. Time needed to access the hospital by road from each municipality was used as a measure of dispersion., Results: The population was distributed into 339 population centers, 90% of which had less than 1,000 inhabitants. The worst communicated populations were smaller (r=-0.194; P<.0001) and had a higher proportion of elderly (r=0.406; P<.0001). No relationship was found between the frequentation of the selected interventions and the number of inhabitants or travel time. Similarly, no differences were found when the analysis was done by pooling the population for 30 minutes isochrones. The percentage of those over 65 years was independently associated to the frequency rate of cataract surgery (beta=0.211; P<.001) and showed a trend to increased frequency for the implantation of pacemakers and hip replacements., Conclusions: Our study shows that, with the current organization of care and in the territory analyzed, neither population dispersion nor aging seems to reduce frequentation of several interventions typical of the elderly population., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Introduction and Objectives: To describe the results of the analysis of pacemaker implantations reported to the Spanish Pacemaker Registry in 2011, with particular reference to the population distribution and the selection of pacing modes., Methods: Information provided by the European Pacemaker Patient Identification Card was processed using a purpose-built computer application., Results: Data from 115 hospitals were analyzed, totaling 13,373 cards, representing an estimated 38% of implantations. The number of pacemaker generators and resynchronization devices implanted was 738 and 56.2 units per million population, respectively. The mean age of the patients who received a device was 76.7 years. Overall, 57.2% of first implantations and 56.5% of replacements were performed in men. Most implantations (38.7%) and generator replacements (41.9%) were performed in patients aged between 80 and 89 years. Of the pacemaker leads used, 99.7% were bipolar and 63% used an active fixation system. Overall, 20% of the patients with atrioventricular block or sick sinus syndrome were paced in VVI/R mode despite being in sinus rhythm., Conclusions: With respect to previous years, the use of conventional pacemakers remained stable and the implantation of resynchronization devices has increased. The number of implantation procedures continues to be higher in men and in younger patients. Age and the degree of blockage remain as factors influencing the appropriate choice of pacing mode., (Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: Our aim is to describe the analysis of the pacemaker implants and replacements reported to the Spanish Pacemaker Registry in 2010, with special reference to the selection of pacing modes., Methods: Data collection was based on the information provided by the European Pacemaker Patient Identification Card, which was processed using a specially designed computer application., Results: Information was received from 101 hospitals, covering a total of 11 648 cards. An estimated 738 pacemaker generators per million population were placed in 2010. The number of pacemaker implantations is higher and the mean age of the recipients lower among men. Overall, 95.5% of the pacemaker leads used were bipolar, 56% employed an active fixation system, and 60% were placed in atrium. The most common electrocardiographic indication was atrioventricular block, followed by sick sinus syndrome. Twenty-four percent of the patients with atrioventricular block and 25.6% of those with sick sinus syndrome are being paced in VVI/R mode (12% of the patients in each group are aged 80 years or under). Cardiac resynchronization device implantation has reached the level of 47 units per million population, 25.7% of which are not associated with implantable cardioverter defibrillators., Conclusions: The upward trend in the use of pacemaker generators continues. The pacemaker leads used are predominantly bipolar, and the majority are active fixation leads. Age remains a factor in the choice of the appropriate pacing mode for the different types of heart disease. This choice could be improved in more than 20% of the cases of pacemaker implantation., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: This article describes the finding of an analysis of all pacemaker implants reported to the Spanish Pacemaker Registry in 2009. Particular attention is paid to patients' demographic characteristics and to the pacing modes selected for various electrocardiographic indications., Methods: The information provided by the European Pacemaker Identification Card was analyzed using a specially developed computer program., Results: Data were received from 106 centers, covering a total of 11,939 cards and corresponding to 35% of all pacemakers implanted. The average age of patients receiving pacemakers was 76.6 years. Overall, 58.4% of pacemakers were implanted in men. The largest number of electrocardiographic indications for a pacemaker was for third-degree atrioventricular block, which comprised 56% of all atrioventricular blocks. The VVIR pacing mode was used for 24.0% of patients with sick sinus syndrome and 23.5% with atrioventricular block. Over 50% of leads employed an active fixation system, and 65% were placed in the atrium., Conclusions: The trend of increasing pacemaker use continued in 2009, reaching 729 units per million population. Pacemaker implantation was more frequent in males, who received them at a slightly younger age than women. Age was a more significant determinant of inappropriate pacing mode selection than electrocardiographic abnormalities. Active fixation of pacemaker leads was used in more than 50% of cases.

Introduction and Objectives: The aim of this report was to describe the results of an analysis of the data on pacemaker implantations reported to the Spanish Pacemaker Registry during 2006. Special emphasis was placed on sociodemographic characteristics and on the pacing modes implemented for different electrocardiographic indications., Methods: The data collected comprised all the information recorded with the European Pacemaker Patient Identification Card. Special software was used for the analysis., Results: Information was received from 105 centers and involved a total of 10,401 cards. It represented 35% of all pacemakers implanted during 2006. The majority of implantations (57.5%) were performed in males, and this applied to all age decades, except the 90s. The average age of patients who received a first implant was 75 years. Atrioventricular block accounted for the greatest number of electrocardiographic indications. Some 25% of patients with sinus node disease received VVI/R pacing despite remaining in sinus rhythm. In addition, 1.5% of implanted devices provided cardiac pacing for ventricular resynchronization, and did not have an associated defibrillator function. Almost all the leads used were bipolar, with only 0.6% being unipolar. In addition, 35.2% of leads were active-fixation leads, while 24.3% of generator used throughout the year were for pulse generator replacement. Some 2.4% of generator replacements were due to erosion or infection., Conclusions: The number of pacemaker implantations and the incidence of conduction disturbance were both greater in males. Correspondingly, first implantations were carried out at a slightly younger age in males. The age decade during which the greatest number of pacemaker implantations was carried out was the 70s, followed by the 80s. Age was one of the factors that influenced the suitability of the pacing mode. In a significant percentage of patients, the pacing mode was inappropriate. The use of active-fixation electrodes continues to increase.

Introduction: The aims of this article were to summarize data on pacemaker implantation reported to the Spanish Pacemaker Registry for 2005 and to provide an analysis of the various electrocardiographic phenomena that lead to pacemaker implantation., Methods: Data were collected using the European Pacemaker Identification Card, with each center individually deciding whether to send the card itself or to submit data in an electronic format., Results: In total, 82 participating centers submitted a total of 9156 cards, which corresponds to 31.9% of pacemakers estimated to have been implanted that year. The average age of patients who received their first implant remained approximately 75 years and, as in previous years, they were more frequently male. In the majority of cases, the indication was atrioventricular block, followed by sick sinus syndrome and then by atrial fibrillation or flutter with atrioventricular block or bradycardia. In 1.35% of the sample analyzed, biventricular stimulation was used for resynchronization. Some 79% of pacemakers were rate-responsive. In practice, all pacemakers used bipolar leads., Conclusions: It was observed that the pacing modes selected were better suited to the various electrocardiographic abnormalities that resulted in pacemaker implantation, in accordance with cardiac stimulation guidelines. In the absence of persistent atrial arrhythmia, age had the greatest influence on pacing mode selection. The more frequent use of pacemakers in males was almost exclusively due to the higher incidence of conduction disorders.

Introduction and Objective: Temporary pacemakers (TP) are used in the emergency treatment of patients with severe bradyarrhythmia. They are often used in emergency situations and for older patients in poor general condition who are hemodynamically unstable and uncooperative. The aim of this study was to review and analyze the indications, incidence and type of complications associated with TP implanted in our center during a 6-year period., Patients and Method: We analyzed significant clinical variables, indication, route of insertion, follow-up, complications, and duration of temporary pacing., Results: A total of 568 TP were implanted, and 530 cases were available for review (mean age 74.8 [11] years). The main indications were symptomatic complete AV block (51%), prophylaxis for replacement with a definitive pacemaker (14.7%), blockage in the acute phase of myocardial infarction (12.6%), bradyarrhythmia due to drug intoxication (12.2%), symptomatic sick sinus syndrome (7.5%) and long QT interval or ventricular tachycardia (2.5%). The route of insertion was via the femoral vein in 99% of the cases. The duration of TP use was 4.2 days (range 1 to 31 days). A total of 369 patients (69.6%) required a permanent pacemaker., Complications: 34 patients died (6.4%), but only 3 deaths were attributable to TP implantation. Other severe complications were seen in 98 patients (18.5%). Malfunction of the TP occurred in 48 patients (9%) because of electrode displacement., Conclusions: Temporary pacemakers are used in older patients with extreme bradyarrhythmia and occasionally with acute myocardial infarction. Serious complications are not uncommon (22% of all patients), and can range from femoral hematoma to cardiac tamponade and even death (6%). In 9% of the patients the electrode needed to be repositioned because of failure of sensing or loss of ventricular capture.

Background: The implantation of pacemakers improves cardiac function and quality of life, in particular with dual chamber DDD and DDDR modes., Aim: To evaluate our clinical experience and results on pacemaker implantation, from 1963 to 1998., Material and Methods: Computerized data collected from 2,445 consecutive paced patients was reviewed. A total of 3,554 operative procedures were performed, including 412 procedures for complications and 697 pacemaker replacement. Patient survival was determined from clinical records, inquiry to pacemaker manufacturers and death certificates from Servicio de Registro Civil e Identificación de Chile (Chilean Civil and Identification Registry)., Results: Use of dual chamber (DDD and DDDR) pacemakers increased progressively up to 74% from 1988 to 1998. Complication rate was 42% in the 1963-1976 study period, it decreased to 10.6% in the 1977-1987 study period, and to 5.6% by 1988-1998. Only two patients died during surgery in the study period (0.08%). In the 1977-1987 period, pacemakers lasted 10.6 years. Survival rates were 52% at ten years, 33% at 15 years, and 21% at 20 years, with a median survival of 11.7 years, and 7.24 years in patients over 80 years old., Conclusions: Transvenous permanent pacing can be accomplished today with a low complication rate, mainly due to better technology and surgical procedures.

Objective: Indication of temporary pacemakers in patients during acute myocardial infarction was widely studied in the pre-thrombolytic era without having determined whether the generalization of fibrinolysis might have changed the overall incidence and significance of temporary pacemakers. Our aim was to determine the incidence and the prognostic significance of insertion of temporary pacemakers in patients with acute myocardial infarction., Patients and Methods: In a study involving 1,239 patients consecutively admitted to hospital with acute myocardial infarction we studied clinical characteristics and prognosis depending on temporary pacemaker insertion or not. We performed an univariate analysis on in-hospital mortality and those selected variables were introduced in to a logistic regression analysis., Results: A temporary pacemaker was indicated in 55 patients (4.4%), prophylactically in 22% and therapeutically in 78%. Temporary pacemakers were inserted in 55% of the patients with advanced AV block and in the 10% of the patients with bundle-branch block. Pacemaker insertion was associated with higher number of affected leads in the ECG, and higher CK peak, regardless of the association with thrombolysis. The following complications were more often observed in patients with temporary pacemakers: atrial fibrillation, heart failure, right bundle-branch block, advanced atrioventricular block and in-hospital mortality (45.4 vs 10.2%; p < 0.001). Need for a temporary pacemaker was less frequent in patients treated with thrombolytics compared with those not treated (3.0 vs 6.1%; p < 0.02). Pacemaker insertion had an independent value for predicting in-hospital mortality (OR = 5.51; 95% CI, 2.71-11.19)., Conclusion: The insertion of a temporary pacemaker in acute myocardial infarction is less frequent nowadays than on the pre-thrombolytic era. Pacemaker insertion is associated with higher indices of infarct extension and in-hospital mortality, having independent prognostic value on the in-hospital mortality.

We report the activity concerning permanent cardiac pacing in Spain during year 1995, based on data submitted to the National Pacemaker Registry corresponding to the European Pacemaker Card. We describe population, etiology and electrocardiographic alterations that determined the need for stimulation and the global distribution of stimulation modes (AAI 1.7%; DDD 20.2%; VDD 11.3% and VVI 66.8%). We emphasize, among other aspects, stimulation in A-V block cases, in sick-sinus syndrome and tendencies compared to 1994's data and limited data corresponding to 1996.

Introduction and Objective: The aim of the present study was to evaluate the complications in patients with functionless pacing leads retained in the cardiovascular system., Patients and Methods: We retrospectively studied 39 patients: 31 underwent surgery for electrical or mechanical failure (group I) and eight for cutaneous pocket infection (group II). The follow-up was 45 +/- 34 months., Results: Only one patient (3%) from group I presented infectious complications probably related to the retained pacing lead. Seven patients (87%) in group II presented recurrence of the infection with persistent fever and/or septicemia due to skin erosion and unnoticed pacing lead infection (p < 0.0005). Removal of the infected generator was performed in 8/39 (21%) of the patients. Thoracotomy to explant the infected retained leads was required in five of them (62%). No patient presented lead migration or venous thrombosis during the follow-up., Conclusions: Retained pacing leads in the cardiovascular system are well tolerated. However, in spite of adequate antibiotic treatment, patients with local and pacemaker system infection may present recurrence of the infection with persistent fever and/or septicemia. Early surgical pacemaker system removal is recommended in these patients due to the high morbidity.

The prevalence of chronotropic incompetence in patients with sinus node disease (SND) is not well defined. To assess this, we evaluated 18 patients (7 men, 11 women; mean age: 64 +/- 11) with SND and permanent pacemakers (AAI/DDD) with Holter monitoring and treadmill stress test. Only 2 patients received active cardiac drugs (1, L-dopa an 1 propafenone). The treadmill tests results were compared with a control group of 15 men and 18 women (mean age: 66 +/- 5, p = NS) without organic heart disease. During ambulatory activity all pacemaker patients increased their own cardiac rate to a value higher than the programmed basic pacemaker rate. In 8 patients the maximal rate attained was over 100/min (mean 95 +/- 19/min). The maximal rate during treadmill test in pacemaker patients was 131 +/- 25 (control group 138 +/- 14, p = NS). Exercise tolerance in METs was similar in pacemaker patients (5.2 +/- 2.6) and in controls (5.8 +/- 1.2) (p = NS). Two pacemaker patients (12%) didn't reach 100/min during stress test. Most patients with SND and permanent pacemakers (AAI/DDD) are able to increase cardiac rate during exercise. Rate responsive pacing (AAIR/DDDR) should be limited to a minority of patients with true chronotropic incompetence.

Definitive pacemakers were placed in 27 children from June 1970 to October 1988. The indication for the pacemakers was congenital auriculoventricular block in 12 patients who were symptomatic; 8 were children with postoperative auriculoventricular block; 4 had developed complete auriculoventricular block from myocardiopathies and 3 from idiopathic sick-sinus syndrome. Two patients died: one 4 months after placement of the pacemaker due to unrelated causes, and the other 14 years later due to fracture of the electrode. There were 23 who were reoperated for different reasons but the most frequent was battery failure in 8 patients and pacemaker malfunction in 4 patients. The electrode was implanted in the epicardium in 21 patients and via subclavian vein into the endocardium in 6 cases. The growth and development physically and mentally were normal during the follow-up of these children. The average follow-up period was 55.6 months.

This paper deals with the study of 927 patients of both sexes, with multiprogramable pacemakers implanted during 1987-1988 period, at the "Comandante Manuel Fajardo" Teaching Hospital and the Institute of Cardiology and Cardiovascular Surgery. Complications accounted for 14.9% and the most frequent were, in decreasing order, as follows: sepsis of the pocket (46.7%), hematoma of the pocket, increased threshold and, in a lower percentage, aseptic necrosis (5.7%). Emphasis is made in the role of the nurse in front of a patient with pacemaker and of the different complications presented.

The results of an investigation made at the request of the Pacemaker Working Group, of the Electrocardiology and Arrhythmias Section, are analysed in order to know the functional and instrumental state of permanent cardiac stimulation in Spain, in two fundamental aspects: A) Pacemakers (MP) implantation and B) their subsequent follow-up. The conclusions reached through these data collected by 86 centres from a total of 115 investigations were: A1) An average of 180 MP per million people are implanted in Spain, of which 48.5% were carried out by cardiac surgeons, 27.5% by cardiologists, 16.7% by intensivists and 7.1% by teams made up from several specialties. The implantation does not mean that the patient must be transferred out from his province of residence, except in certain areas (La Rioja, Palencia, etc.). A2) Bicameral stimulation was not used in one third of the centres questioned. A3) Material conditions for implantation are, in general, adequate. A4) Endocavitary implantation technique is used in 99% of cases, with venous approach through percutaneous puncture of subclavian vein in 37.3% of cases. A5) The professional group most recently incorporated into cardiac stimulation is that of intensivists. A6) The most limited diagnostic methods are electrophysiology and nuclear cardiac technique. B1) Uneven geographical distribution of pacemaker control units (UCM) was found. B2) The main hierarchy dependence of the UCMs belongs to Cardiology Units. B3) Proportion of specially dedicated UCMs and of in vitro study laboratories is scarce. B4) Important participation of pacemaker manufacturing companies in the implementation of UCMs is found.