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.

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.

[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.