Spanish Pacemaker Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2016).

INTRODUCTION AND OBJECTIVES: This report describes the results of analysis of implanted pacemakers reported to the Spanish Pacemaker Registry. METHODS: The analysis was based on information provided by the European Pacemaker Identification Card. RESULTS: Information was received from 115 hospitals, with a total of 12 697 cards, representing 32.3% of the estimated activity. Use of conventional and resynchronization pacemakers was 818 and 79 units per million inhabitants, respectively. A total of 200 leadless pacemakers were implanted. The mean age of the patients receiving an implant was 77.8 years, and 52% of devices were implanted in persons older than 80 years. In all, 74.9% were first implants and 23.4% corresponded to generator exchange. Endocardial leads were bipolar, 82.9% with active fixation, and 16.1% had magnetic resonance imaging protection. Most patients received bicameral sequential pacing, although single chamber pacing VVI(R) was used in 26.7% of the patients with sick sinus syndrome and in 23.8% of those with atrioventricular block, despite sinus rhythm. CONCLUSIONS: Total use of pacemaker generators in Spain has increased by 1.6% compared with 2015. Most implanted leads have active fixation and less than 20% have magnetic resonance imaging protection. Age and sex directly influenced pacing mode selection, which could be improved in around 32% of patients.

Spanish Pacemaker Registry. Thirteenth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2015).

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.

Sequential Atrioventricular Pacing in Patients With Hypertrophic Cardiomyopathy: An 18-year Experience.

INTRODUCTION AND OBJECTIVES: Controversy persists regarding the role of sequential atrioventricular pacing in patients with obstructive hypertrophic cardiomyopathy and disabling symptoms. The aim of this study was to evaluate the effect of pacing on symptoms, dynamic gradient, and left ventricular function in patients with hypertrophic cardiomyopathy. METHODS: From 1991 to 2009, dual-chamber pacemakers were implanted in 82 patients with obstructive hypertrophic cardiomyopathy and disabling symptoms despite optimal medical therapy. Sequential pacing was performed with a short atrioventricular delay. Clinical and echocardiographic parameters were measured before and immediately after implantation and after a long follow-up (median, 8.5 years [range, 1-18 years]). RESULTS: The New York Heart Association functional class was immediately reduced after pacemaker implantation in 95% of patients (P < .0001), and this improvement was maintained until the final follow-up in 89% (P = .016). The gradient was significantly reduced after implantation (94.5 ± 36.5 vs 46.4 ± 26.7mmHg; P < .0001) and at final follow-up (94.5 ± 36.5 vs 35.9 ± 24.0mmHg; P < .0001). Mitral regurgitation permanently improved in 52% of the patients (P < .0001). There were no differences in ventricular thickness or diameters, ejection fraction, or diastolic function. CONCLUSIONS: Sequential pacing in selected patients with obstructive hypertrophic cardiomyopathy improves functional class and reduces dynamic gradient and mitral regurgitation immediately after pacemaker implantation and at final follow-up. Prolonged ventricular pacing has no negative effects on systolic or diastolic function in these patients.

Spanish Pacemaker Registry. Twelfth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2014).

INTRODUCTION AND OBJECTIVES: This report describes the results of the analysis of pacemaker implant and replacement data submitted to the Spanish Pacemaker Registry in 2014, with special reference to pacing mode selection. METHODS: The report is based on the processing of information provided by the European Pacemaker Patient Identification Card. RESULTS: Information was received from 117 hospitals, with a total of 12 358 cards, representing 34% of estimated activity. Use of conventional generators and resynchronization devices was 784 and 64.4 units per million population, respectively. The mean age of patients receiving an implant was 77.3 years. Men received 59% of implants and 56.4% of replacements. Most patients receiving generator implants and replacements were in the age range 80 to 89 years. Most endocardial leads used were bipolar, and 84.2% had an active fixation system. Pacing was in VVI/R mode despite being in sinus rhythm in 24.7% of patients with sick sinus syndrome and 24% of those with atrioventricular block. CONCLUSIONS: The use of pacemaker generators and resynchronization devices per million population continued to increase. Most implanted leads had active fixation and approximately 20% had magnetic resonance imaging protection. Age and sex directly influenced pacing mode selection, which could have been improved in more than 20% of cases.

Spanish Pacemaker Registry. Eleventh official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2013).

INTRODUCTION AND OBJECTIVES: The present report summarizes the analysis of pacemaker implantation and replacement data sent to the Spanish Pacemaker Registry in 2013, with specific discussion of pacing mode selection. METHODS: This study was based on information obtained from the European Pacemaker Patient Identification Card. RESULTS: Information was received on 118 hospital centers, with a total of 12 831 cards, or 35% of the estimated activity. There were 755 and 58.1 conventional and resynchronization devices per million population, respectively. The mean age of patients receiving an implant was 77.4 years. Men received 59.5% of first implantations and 56.6% of replacements. Most implantations and generator replacements were performed in patients older than 80 years. Almost all endocardial leads used were bipolar, and 78.7% of leads had an active fixation mechanism. Despite being in sinus rhythm, 24% of patients with sick sinus syndrome and 25% of those with atrioventricular block were paced in VVIR mode. CONCLUSIONS: The use of pacemaker generators and resynchronization devices per million population continues to increase in Spain. Active fixation mechanisms predominate for leads but just 20% of leads are compatible with magnetic resonance imaging. The factors influencing the correct selection of pacing mode were age and, to a lesser extent, the type of atrioventricular block, and sex. Implementation of home monitoring of pacemakers remains low.

Spanish pacemaker registry. 10th official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2012).

INTRODUCTION AND OBJECTIVES: Our aim was to analyze the pacemaker implantations and replacements reported to the Spanish Pacemaker Registry in 2012 with special reference to the selection of pacing modes. METHOD: The analysis was based on information provided by the European Pacemaker Patient Identification Card. RESULTS: Data were received from 115 hospitals, with a total of 12 856 cards. An estimated 745.8 pacemaker generators and 53.1 resynchronization devices were implanted per million population. Active fixation leads were implanted in more than 70% of the patients; of these leads, more than 20% were safe for use with magnetic resonance. The most common electrocardiographic indication for pacemaker implantation was atrioventricular block (56%). In all, 28% of the patients with sick sinus syndrome were paced in VVIR mode. CONCLUSIONS: The use of conventional pacemakers remained stable, whereas the implantation of resynchronization devices increased. Active fixation leads are now employed in most patients. The findings of this study confirm the higher incidence of implantation in men and at an earlier age due to the higher rate of conduction disorders. Age is a factor that influences the choice of the appropriate pacing mode.

Spanish Pacemaker Registry. Ninth official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2011).

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.

[Spanish pacemaker registry. Eighth official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2010)]. / Registro Español de Marcapasos. VIII Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2010).

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.

Spanish Pacemaker Registry. Seventh official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2009).

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.

Spanish Pacemaker Registry. Fifth official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2007).

INTRODUCTION AND OBJECTIVES: The aim of this article was to report findings from the Spanish Pacemaker Registry on procedures carried out in 2007. The analysis includes details of patients' demographic characteristics, the type of procedure (i.e., implant or replacement), pacing mode, and the electrode and fixation systems used. METHODS: The data collected comprised all the information recorded on European Pacemaker Patient Identification Cards, which were submitted voluntarily in either electronic or paper form. RESULTS: The information received from 114 health-care centers included 11 360 cards, which covered 36.9% of all pacemakers thought to be implanted during 2007. Some 680.4 pacemakers were used per million inhabitants. Usage varied significantly between different Spanish autonomous regions, partly due to uneven ageing of the population. Some 25.3% of all procedures were to replace generators. The average age of patients undergoing a first implantation was 76.1 years, with a difference between the sexes: 75.4 years in men and 77.1 years in women. First implantations were carried out most often in patients in their 70s, who comprised 40% of the total, compared with other decades of life. There were more first implantations in men, who accounted for 57.9% of the total, due to a higher incidence of intraventricular conduction disturbance. In contrast, sick sinus syndrome was equally common in both sexes. Leaving aside patients with atrial tachyarrhythmia, it was observed that the VVI/R mode was used in 26.2% of those with sick sinus syndrome, 28% with atrioventricular block and 28.1% with intraventricular conduction disturbance. Age had a great influence on whether this pacing mode was selected. Almost all leads used were bipolar. The percentage using active fixation increased to 36.5%. The percentage of implants involving low-energy cardiac resynchronization therapy remained unchanged. CONCLUSIONS: The Spanish Pacemaker Registry received data on a highly representative sample of patients requiring cardiac pacing in 2007, which covered 11 360 device implantations or replacements. It was observed that the incidence of first implantations was influenced by sex, being greater in males, who underwent implantation at a younger age because conduction disturbances were more common. Age was one factor influencing the pacing mode selected for a range of electrocardiographic indications for pacing. Almost all leads implanted were bipolar. The percentage using active fixation continues to increase.

[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.

[Spanish pacemaker registry. Third official report of the Spanish Society of Cardiology Working Group on Cardiac Stimulation (2005)]. / Registro Español de marcapasos. III informe oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2005).

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.

[Spanish Registry of Pacemakers. Second Official Report of the Working Group on Cardiac Stimulation of the Spanish Society of Cardiology (1994-2003)]. / Registro Español de Marcapasos. II Informe Oficial de la Sección de Estimulación Cardíaca de la Sociedad Española de Cardiología (1994-2003).

This report describes the data of the Spanish Registry of Pacemakers, based on the European Pacemaker Identification Card, and the changes in the use of different stimulation modes since 1994. Of note is the significant and steady change towards more physiological modes of stimulation (which maintain atrioventricular synchrony). These modes accounted in 2003 for 69.9% among patients with sick sinus syndrome and 67.7% among patients with atrioventricular block. In the population less than 80 years of age these percentages were 78% for sick sinus syndrome and 78.7% for atrioventricular block. The vast majority of electrodes implanted for stimulation were bipolar.