Remote monitoring in a patient with multiple leadless pacemakers.

We describe through a clinical case some of the challenges we can face when remotely monitoring a patient with two devices. The case describes a patient with two leadless pacemaker in which data transmission by remote monitoring has been achieved.

Rendimiento del marcapasos cardiaco Micra en nonagenarios / Performance of the Micra cardiac pacemaker in nonagenarians

INTRODUCCIÓN Y OBJETIVOS: El marcapasos transcatéter Micra presenta una alta efectividad y una tasa de complicaciones más baja que los marcapasos convencionales. Sin embargo, se desconoce su beneficio en la población más anciana (≥ 90 años). El objetivo de este estudio es evaluar la efectividad y la seguridad de Micra en pacientes de edad ≥ 90 años. MÉTODOS: Estudio observacional prospectivo con pacientes consecutivos mayores de 70 años a los que se implantó un marcapasos Micra, divididos en 2 grupos de edad: ≥ 90 y <90 años. RESULTADOS: El Micra se implantó en 129 pacientes, 41 tenían 90 o más años y 88, menos de 90. El implante fue exitoso en 40 pacientes (97,6%) de edad ≥ 90 años y en 87 (98,9%) menores de 90 (p = 0,58). Fueron necesarias 2 o menos reposiciones en el 97,5 y el 91,9% de los pacientes respectivamente (p = 0,32). Los tiempos de procedimiento (26,1±11,6 frente a 30,3±14,2min; p = 0,11) y de fluoroscopia (6,4±4,7 frente a 7,2±4,9min; p = 0,41) fueron similares en ambos grupos. Hubo 3 complicaciones mayores (2,3%), todas en el grupo menor de 90 años: 1 perforación cardiaca, 1 hematoma femoral y 1 seudoaneurisma femoral. Un total de 13 pacientes de edad ≥ 90 años (31,7%) y 16 de los menores de 90 (18,2%) murieron durante unos seguimientos medios de 230±233 y 394±285 días respectivamente. No hubo muertes relacionadas con el dispositivo. No se observaron infección, dislocación o migración de Micra. El rendimiento eléctrico fue óptimo en el seguimiento. CONCLUSIONES: El marcapasos sin cables Micra parece efectivo y seguro en pacientes mayores de 90 años. Podría considerarse una alternativa razonable a la estimulación transvenosa convencional en esta población

INTRODUCTION AND OBJECTIVES: The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years. METHODS: We present a prospective observational study with consecutive patients aged >70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and<90 years. RESULTS: The Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88<90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients<90 years (P=.58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively (P=.32). Procedure time (26.1 ±11.6 vs 30.3 ±14.2minutes; P=.11) and fluoroscopy time (6.4 ±4.7 vs 7.2 ±4.9minutes; P=0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged<90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged <90 years (18.2%) died during a mean follow-up of 230±233 days and 394±285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. CONCLUSIONS: The Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population

Performance of the Micra cardiac pacemaker in nonagenarians.

INTRODUCTION AND OBJECTIVES: The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years. METHODS: We present a prospective observational study with consecutive patients aged >70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and<90 years. RESULTS: The Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88<90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients<90 years (P=.58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively (P=.32). Procedure time (26.1 ±11.6 vs 30.3 ±14.2minutes; P=.11) and fluoroscopy time (6.4 ±4.7 vs 7.2 ±4.9minutes; P=0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged<90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged <90 years (18.2%) died during a mean follow-up of 230±233 days and 394±285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. CONCLUSIONS: The Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population.

Bloqueo auriculoventricular infrahisiano secundario a radioterapia / Infra-hisian atrioventricular block secondary to radiotherapy

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[Arrhythmias and cardiac electrophysiology]. / Arritmias y electrofisiología cardiaca.

This article contains a review of some of the most significant advances in cardiac arrhythmias that have taken place in the last year, particularly those concerning the most common clinical conditions associated with the risk of arrhythmia, such as sudden cardiac death, atrial fibrillation and syncope, and genetically determined and hereditary heart disease, as well as advances concerning the principal nonpharmacologic treatments, such as catheter ablation, and the use of implantable defibrillators and cardiac resynchronization therapy.