[Progress in cardiac pacing]. / Novedades en estimulación cardiaca.

This review article summarizes the fundamental principles of radiological protection for interventional cardiologists. In addition, the scientific articles on cardiac pacing that have had the greatest impact in the last year are also summarized. Two cardiac pacing techniques are described: His-bundle pacing and cardiac contractility modulation.

Novedades en estimulación cardiaca / Progress in cardiac pacing

En esta revisión se abordan los conocimientos básicos para la protección radiológica del cardiólogo intervencionista. Se realiza un resumen de los artículos científicos sobre estimulación cardiaca de mayor impacto durante el último año. Se describen dos técnicas de estimulación: la estimulación hisiana y la modulación de la contractilidad cardiaca (AU)

This review article summarizes the fundamental principles of radiological protection for interventional cardiologists. In addition, the scientific articles on cardiac pacing that have had the greatest impact in the last year are also summarized. Two cardiac pacing techniques are described: His-bundle pacing and cardiac contractility modulation (AU)

[Spanish Pacemaker Registry. Fourth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Stimulation (2006)]. / Registro Español de Marcapasos. IV Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2006).

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.

Registro Español de Marcapasos. IV Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2006) / Spanish Pacemaker Registry. Fourth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Stimulation (2006)

Introducción y objetivos. Se describe el resultado del análisis de los implantes de marcapasos remitidos al Registro Español de Marcapasos correspondientes al año 2006. Se hace especial énfasis en la distribución poblacional y en los modos de estimulación utilizados en las diversas indicaciones electrocardiográficas. Métodos. La recogida de la información es la que aporta la Tarjeta Europea del Paciente Portador de Marcapasos en sus diversos campos. Se utiliza una aplicación informática específica para su explotación. Resultados. Se recibió información de 105 centros, con un total de 10.401 tarjetas, lo que supone el 35% de todos los marcapasos implantados. La incidencia de implantes es superior en los varones, con un 57,5%, y lo es en todas las décadas de la vida, a excepción de los 90 años. La media de edad del paciente que recibe el primer implante fue de 75 años. El mayor número de las indicaciones electrocardiográficas corresponde a los bloqueos auriculoventriculares. El 25% de los pacientes con enfermedad del nódulo sinusal se estimulan en modo VVI/R a pesar de permanecer en ritmo sinusal. La estimulación para terapia de resincronización ventricular, sin asociar capacidad de desfibrilación, supone el 1,5% de los implantes. Casi la totalidad de los cables utilizados fueron bipolares, sólo un 0,6% unipolares. El porcentaje de fijación activa en los cables fue del 35,2% y el de recambios de generadores, el 24,3% de los consumidos en el año. En el 2,4% de los recambios la causa fue la erosión o infección. Conclusiones. Hay un mayor número de implantes de marcapasos y una mayor incidencia de trastornos de la conducción en los varones; en éstos, el primer implante es a una edad ligeramente inferior. La década con mayor número de implantes corresponde a los 70 años, seguida de los 80. La edad es un factor influyente en la correcta adecuación del modo de estimulación. Un porcentaje significativo de pacientes estimulados lo son en un modo no idóneo. Sigue aumentando la fijación activa en los cables utilizados (AU)

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 (AU)

[Current topics (2005) in cardiac pacing]. / Temas de actualidad en estimulación cardíaca 2005.

Currently, three areas of active development in cardiac pacing are of particular interest to clinical cardiologists. Biventricular pacing is now considered a type-I indication for adjuvant treatment in advanced and refractory heart failure. Consequently, some changes in everyday clinical practice will be seen when patients with end-stage heart failure start to receive resynchronization therapy. Secondly, the Cardiac Pacing Working Group of the Spanish Society of Cardiology has developed a national consensus document on sleep apnea and cardiac rhythm abnormalities. It appears that a novel way of tackling the current growing epidemic could be to use permanent cardiac pacing in an attempt to modify the cardiac rhythm alterations, mainly bradyarrhythmias, related to sleep apnea. Finally, promising developments are taking place in systems designed to reduce the unwanted right ventricular stimulation sometimes observed with antibradycardia pacing modalities. These new systems are expected to minimize significantly the well-known deleterious hemodynamic effects sometimes seen in our patients.

Temas de actualidad en estimulación cardíaca 2005 / Current Topics (2005) in Cardiac Pacing

De acuerdo con los objetivos de las monografías de Temas de Actualidad en Cardiología, y en lo que se refiere a avances en estimulación cardíaca durante el año 2005, conviene destacar para el clínico 3 aspectos de interés. El tratamiento coadyuvante en la insuficiencia cardíaca avanzada y refractaria mediante estimulación biventricular con marcapasos ha pasado a ser una indicación de tipo I, con lo que cabe esperar modificaciones en la práctica clínica. Por otra parte, la Sección de Estimulación Cardíaca, en nombre de la Sociedad Española de Cardiología, ha participado en la elaboración de un documento de consenso nacional sobre enfermedad del sueño donde quedan recogidas las diferentes alteraciones cardíacas relacionadas con el síndrome de apnea del sueño. Las enfermedades del ritmo cardíaco y, en especial, las bradiarritmias constituyen en la actualidad una línea novedosa de investigación para conocer la posibilidad de influir positivamente en la evolución de este síndrome mediante estimulación cardíaca permanente. Finalmente, se tratará sobre los sistemas diseñados para reducir la estimulación innecesaria en el ventrículo derecho que en muchas ocasiones se produce con las diversas modalidades de estimulación antibradicardia. Estos novedosos sistemas evitarán, en buena parte de los pacientes, los conocidos efectos perjudiciales que con frecuencia se observan durante la estimulación en el ápex de ventrículo derecho (AU)

Currently, three areas of active development in cardiac pacing are of particular interest to clinical cardiologists. Biventricular pacing is now considered a type-I indication for adjuvant treatment in advanced and refractory heart failure. Consequently, some changes in everyday clinical practice will be seen when patients with end-stage heart failure start to receive resynchronization therapy. Secondly, the Cardiac Pacing Working Group of the Spanish Society of Cardiology has developed a national consensus document on sleep apnea and cardiac rhythm abnormalities. It appears that a novel way of tackling thecurrent growing epidemic could be to use permanent (..) (AU)