Outcomes of a 24/7 service for urgent permanent pacemaker implantation.

INTRODUCTION AND OBJECTIVES: Most of the complications associated with acute and symptomatic bradyarrhythmia (ASB) occur in the time from diagnosis to permanent pacemaker implantation (PPI). We aimed to evaluate the outcomes of an urgent 24/7 PPI service (PPI-24/7) for patients with ASB. METHODS: A total of 664 patients undergoing first-time PPI for ASB were prospectively assessed during 2 periods of identical length (18 months): 341 patients who underwent the procedure during working hours only (PPI-WH), and 323 patients who underwent the procedure after the implementation of the PPI-24/7 service. The primary safety endpoint was established as the cumulative 180-day incidence of complications related to the index arrhythmia and device implant. The primary efficacy endpoint was determined as the average number of hospital stays per patient. RESULTS: The PPI-24/7 period was associated with a significant shortening of the time from diagnosis to implantation (median [interquartile range]): 3hours [2-6] vs 16 [5-21]). The cumulative incidence of patients with complications at 180 days was lower in the PPI-24/7 period: 9% vs 17% (adjusted odds ratio, 0.5; P=.002), due to a significant reduction in preimplant complications: 2.5% vs 12% (P <.001). The average number of hospital stays was reduced by 2 per patient in the PPI-24/7 period (nonparametric P <.001). PPI-24/7 implants performed outside working hours (n=178) were safe, with a 180-day cumulative incidence in procedure-related complications of 3.9%. CONCLUSIONS: Among patients with ASB, PPI-24/7 was associated with a significant reduction in patient morbidity and efficient hospital resource use.

Diferencias clínicas entre la amiloidosis cardiaca por transtirretina y la cardiopatía hipertensiva / Clinical differences between transthyretin cardiac amyloidosis and hypertensive heart disease

Introducción: Un porcentaje importante de pacientes finalmente diagnosticados de amiloidosis cardIaca por transtirretina (ATTR) fueron previamente diagnosticados de cardiopatía hipertensiva (CHTA), ya que ambas enfermedades suelen cursar con insuficiencia cardíaca (IC) con fracción de eyección preservada (ICFEp) e hipertrofia ventricular. Nuestros objetivos fueron evaluar las diferencias clínicas, electrocardiográficas y ecocardiográficas, y analizar si existe un pronóstico diferencial entre ambas entidades nosológicas. Material y métodos: Se incluyeron retrospectivamente todos los pacientes con CHTA a los que se solicitó una gammagrafía cardíaca con 99mTc-Difosfonatos (GDPD) y estudio de cadenas ligeras en sangre y orina para despistaje de ATTR en nuestro centro, en el periodo 2016-2021. Para el análisis, se excluyeron aquellos diagnosticados de otros tipos de amiloidosis. Resultados: Se analizaron un total de 72 pacientes: 33 fueron diagnosticados de ATTR y 39 de CHTA, finalmente. Los pacientes con ATTR presentaron mayores niveles de troponina I ultrasensible (TnI-US) y propéptido natriurético cerebral N-terminal (NT-ProBNP); en electrocardiograma (ECG) presentaron más frecuentemente patrón de seudoinfarto y alteraciones de la conducción; en ecocardiograma transtorácico (ETT) presentaron mayor grado de hipertrofia ventricular, disfunción ventricular izquierda y parámetros de peor función diastólica, con presiones de llenado más elevadas. En el seguimiento a 4 años, el grupo de ATTR mostró mayor necesidad de marcapasos (MCP), sin evidenciarse evidencias en cuanto a mortalidad, desarrollo de fibrilación auricular o más ingresos por IC. Conclusiones: En nuestra serie, los pacientes con ATTR presentaron diferencias clínicas, electrocardiográficas y ecocardiográficas respecto a aquellos con CHTA, con mayor riesgo necesidad de MCP en el seguimiento.(AU)

Introduction: A significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis (TTRA) was previously diagnosed with hypertensive heart disease (HHD), since both conditions usually present with heart failure (HF) with preserved ejection fraction (HFpEF) and ventricular hypertrophy. Our objectives were to evaluate the clinical, electrocardiographic and echocardiographic differences, and to analyse whether there exists a differential prognosis between these two nosological entities. Materials and methods: We retrospectively included all patients with HHD for whom a cardiac scintigraphy with 99mTc-diphosphonate (GDPD) and a free light chains test in blood and urine were ordered for ATTR screening in our centre, in the period between 2016 and 2021. Those diagnosed with other types of amyloidosis were excluded from the analysis. Results: A total of 72 patients were analyzed: 33 were finally diagnosed with TTRA and 39 with CHTA. Patients with TTRA had higher levels of ultrasensitive troponin I (TnI-US) and N-terminal brain natriuretic propeptide (NT-ProBNP); in electrocardiography (ECG) they presented a pseudo-infarction pattern more frequently as well as conduction disturbances; in echocardiography (TTE) they presented a higher degree of ventricular hypertrophy, left ventricular dysfunction and worse diastolic function parameters, with elevated filling pressures. In the 4-year follow-up, the ATTR group showed greater need for pacemaker (PCM), with no evidence regarding mortality, development of atrial fibrillation (AF), or more admissions for heart failure (HF). Conclusions: In our series, patients with TTRA showed clinical, electrocardiographic and echocardiographic differences compared to patients with HHD, with increased risk of need for PCM.(AU)

Impacto de la pandemia por COVID-19 en el implante de dispositivos cardiacos implantables y las activaciones de la monitorización a distancia / Impact of the COVID-19 pandemic on implantation of cardiac implantable electronic devices and remote monitoring activations

Introducción y objetivos La monitorización a distancia (MD) de los dispositivos cardiacos implantables (DCI) se considera más fiable, eficiente y segura que los convencionales seguimientos presenciales, aunque su implantación es aún subóptima. Este estudio pretende analizar el impacto de la pandemia de COVID-19 en las tasas de implantes y activaciones de MD de DCI en España. Métodos Se utilizó el Registro COVID-19 de MD en España para analizar el número mensual de todos los implantes de DCI y activaciones de MD desde enero de 2018 hasta diciembre de 2021 en España. Se sumaron los datos de los 5 principales fabricantes de DCI y se analizaron de manera descriptiva. Resultados Se registró un total de 205.345 DCI. El número de implantes disminuyó bruscamente (48,2%) con el confinamiento (marzo a junio de 2020) y aumentó progresivamente después hasta compensar la reducción previa, excepto en marcapasos y desfibriladores automáticos implantables (DAI), con una pérdida agregada (2020-2021) del 7 y el 3%, respectivamente, respecto a la media anual. Aumentaron la terapia de resincronización cardiaca con desfibrilador (TRC-D, 17%) y con marcapasos (TRC-P, 4,5%) a los 2 años. El porcentaje de activaciones de MD aumentó del 24,5% en 2018 al 49,0% en 2021, con un fuerte aumento durante el confinamiento. Las tasas de activación de MD aumentaron invariablemente durante el confinamiento con todos los dispositivos: marcapasos (el 14,4 frente al 37,2%; p<0,001); DAI (el 75,6 frente al 94,2%; p<0,001); TRC-D/TRC-P (del 68,6/44,2% al 81,6/61%; p<0,001), y Holters implantables (el 50,2 frente al 68,7%; p<0,001). Conclusiones La significativa reducción de los implantes que se produjo durante el confinamiento se recuperó gradualmente después, excepto los de marcapasos y DAI. La pandemia de COVID-19 impulsó la MD de todos los DCI en España. (AU)

Introduction and objectives Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is considered more reliable, efficient, and safer than conventional in-person follow-up. However, the implementation of RM is still suboptimal. This study aimed to analyze the impact of the COVID-19 pandemic on the rates of CIED implants and RM activations in Spain. Methods The COVID-19 RM Spain Registry was used to analyze the monthly number of all CIED implantations and RM activations from January 2018 to December 2021. A descriptive analysis was performed using aggregated data from the five major CIED manufacturers. Results A total of 205 345 CIEDs were recorded. The number of implants decreased sharply (48.2%) during the pandemic lockdown (March-June 2020) but gradually increased thereafter, compensating for the previous reduction. However, pacemakers and implantable cardiac defibrillators (ICD) showed an aggregate loss of 7% and 3%, respectively, from the annual average during 2020-2021. In contrast, cardiac resynchronization therapy defibrillators (CRT-D) increased by 17%, and pacemakers (CRT-P) by 4.5% over the 2-year period. The percentage of RM activations increased from 24.5% in 2018 to 49.0% in 2021, with a sharp increase during the lockdown. The RM activation rates consistently increased during the lockdown for all devices: pacemakers (14.4% vs 37.2%; P<.001); ICD (75.6% vs 94.2%; P<.001); CRT-D/CRT-P (68.6-44.2% vs 81.6-61%; P<.001), and implantable loop recorders (50.2% vs 68.7%; P<.001). Conclusions The significant decline in implants during the lockdown gradually recovered, except for pacemakers and ICD. However, the COVID-19 pandemic boosted RM for all CIEDs in Spain. (AU)

Self-expanding TAVI using the cusp overlap technique versus the traditional technique: electrocardiogram changes and 1-year cardiovascular outcomes.

INTRODUCTION AND OBJECTIVES: Transcatheter aortic valve implantation (TAVI) using the cusp overlap technique (COT) has shown a lower pacemaker implantation rate at 30 days. The objective of this study was to compare electrocardiogram changes and clinical outcomes between COT and the traditional technique (TT) at 1 year of follow-up. METHODS: Observational, retrospective, nonrandomized study of consecutive patients undergoing TAVI between January 2015 and January 2021. Patients were matched using a propensity score and the TT was compared with COT. The primary endpoints were electrocardiogram changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year. RESULTS: We included 254 patients. After propensity score matching, 184 patients (92 per group) remained. There were no statistically significant differences in baseline characteristics. At 1 year, COT patients showed a significant reduction in new onset left bundle branch block (49% vs 27%, P=.002) and less P wave (13.1±21.0 msec vs 5.47±12.5 msec; P=.003) and QRS prolongation (29.77±27.0 msec vs 16.38±25.4 msec, P <.001). COT was associated with a significant reduction in the occurrence of the primary endpoint (SHR, 0.39 [IC95%, 0.21-0.76]; P=.005). CONCLUSIONS: At 1 year of follow-up, COT reduced the incidence of new onset left bundle branch block and diminished QRS and P wave widening compared with the TT. COT was also associated with a statistically significant reduction in the occurrence of the combined primary cardiovascular endpoint.

Impact of the COVID-19 pandemic on implantation of cardiac implantable electronic devices and remote monitoring activations.

INTRODUCTION AND OBJECTIVES: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is considered more reliable, efficient, and safer than conventional in-person follow-up. However, the implementation of RM is still suboptimal. This study aimed to analyze the impact of the COVID-19 pandemic on the rates of CIED implants and RM activations in Spain. METHODS: The COVID-19 RM Spain Registry was used to analyze the monthly number of all CIED implantations and RM activations from January 2018 to December 2021. A descriptive analysis was performed using aggregated data from the five major CIED manufacturers. RESULTS: A total of 205 345 CIEDs were recorded. The number of implants decreased sharply (48.2%) during the pandemic lockdown (March-June 2020) but gradually increased thereafter, compensating for the previous reduction. However, pacemakers and implantable cardiac defibrillators (ICD) showed an aggregate loss of 7% and 3%, respectively, from the annual average during 2020-2021. In contrast, cardiac resynchronization therapy defibrillators (CRT-D) increased by 17%, and pacemakers (CRT-P) by 4.5% over the 2-year period. The percentage of RM activations increased from 24.5% in 2018 to 49.0% in 2021, with a sharp increase during the lockdown. The RM activation rates consistently increased during the lockdown for all devices: pacemakers (14.4% vs 37.2%; P <.001); ICD (75.6% vs 94.2%; P <.001); CRT-D/CRT-P (68.6-44.2% vs 81.6-61%; P <.001), and implantable loop recorders (50.2% vs 68.7%; P <.001). CONCLUSIONS: The significant decline in implants during the lockdown gradually recovered, except for pacemakers and ICD. However, the COVID-19 pandemic boosted RM for all CIEDs in Spain.

[Clinical differences between transthyretin cardiac amyloidosis and hypertensive heart disease]. / Diferencias clínicas entre la amiloidosis cardiaca por transtirretina y la cardiopatía hipertensiva.

INTRODUCTION: A significant percentage of patients eventually diagnosed with cardiac transthyretin amyloidosis (TTRA) was previously diagnosed with hypertensive heart disease (HHD), since both conditions usually present with heart failure (HF) with preserved ejection fraction (HFpEF) and ventricular hypertrophy. Our objectives were to evaluate the clinical, electrocardiographic and echocardiographic differences, and to analyse whether there exists a differential prognosis between these two nosological entities. MATERIALS AND METHODS: We retrospectively included all patients with HHD for whom a cardiac scintigraphy with 99mTc-diphosphonate (GDPD) and a free light chains test in blood and urine were ordered for ATTR screening in our centre, in the period between 2016 and 2021. Those diagnosed with other types of amyloidosis were excluded from the analysis. RESULTS: A total of 72 patients were analyzed: 33 were finally diagnosed with TTRA and 39 with CHTA. Patients with TTRA had higher levels of ultrasensitive troponin I (TnI-US) and N-terminal brain natriuretic propeptide (NT-ProBNP); in electrocardiography (ECG) they presented a pseudo-infarction pattern more frequently as well as conduction disturbances; in echocardiography (TTE) they presented a higher degree of ventricular hypertrophy, left ventricular dysfunction and worse diastolic function parameters, with elevated filling pressures. In the 4-year follow-up, the ATTR group showed greater need for pacemaker (PCM), with no evidence regarding mortality, development of atrial fibrillation (AF), or more admissions for heart failure (HF). CONCLUSIONS: In our series, patients with TTRA showed clinical, electrocardiographic and echocardiographic differences compared to patients with HHD, with increased risk of need for PCM.

Corrected sinus node recovery time as a screening test in patients with typical atrial flutter post-ablation to predict pacemaker implantation / Tiempo de recuperación del nodo sinusal corregido como prueba de tamizaje en pacientes con aleteo atrial típico postablación para predecir la implantación de marcapasos

Abstract Objective: The objective of the study was to establish the prognostic value of CSNRT regarding the necessity for pacemaker implantation in patients with atrial flutter (AFL) post-ablation. Methods: This prospective cohort study, conducted at the National Institute of Cardiology "Ignacio Chavez" in Mexico City, assessed patients who had undergone ablation procedures to correct AFL, posterior to which an autonomic blockade was performed, and CSNRT was measured. Results: The sample for this investigation was 40 patients. These were subdivided into two study groups depending on their requirement of pacemaker implant post-ablation (Pacemaker P, No Pacemaker NP). Sinus node (SN) dysfunction was diagnosed in 13 (32.5%) of the 40 participants, 10 (71.43%) of which required a pacemaker implant, while only 4 participants (28.57%) with normal SN function required pacemakers. Ten out of the 14 patients (71.43%) who required a pacemaker had an elevated CSNRT > 500 ms (p ≤ 0.01). Post-ablation CSNRT mean was 383.54 ms ± 67.96 ms in the NP group versus 1972.57 ms ± 3423.56 ms in the P group. Furthermore, SN pause in the P group had a mean of 1.86 s ± 0.96 s versus the NP group with 1.196 s ± 0.52 s. Conclusion: CSNRT has the potential to be a quantitative prognostic tool for the assessment of future pacemaker implants in patients with AFL post-ablation. This could aid in the timely diagnosis of sinus node dysfunction, which could, in the long run, result in the reduction of cardiac functional capacity loss due to cardiac remodeling.

Resumen Objetivo: Establecer el valor pronóstico del TRNSC basado en la necesidad de marcapasos en pacientes diagnosticados con aleteo atrial, pos-ablación. Métodos: Este cohorte prospectivo, realizado en el Instituto Nacional de Cardiología "Ignacio Chávez" en la Ciudad de México, evaluó pacientes sometidos a ablación para corregir el aleteo atrial; se midió el TRNSC post bloqueo autonómico. Resultados: La muestra de 40 pacientes se subdividió en 2 grupos según su requerimiento de marcapasos posterior a la ablación (P y NP). Se diagnosticó disfunción del nodo sinusal en 13 participantes (32.5%), de los cuales 10 (71.43%) requirieron marcapasos en comparación a 4 (28.57%) con función normal. En el grupo P la pausa del nodo sinusal post-ablación tuvo una media de 1.86 ± 0.96 s versus el grupo NP con 1.196 ± 0.52 s. En relación con el TRNSC, el grupo NP tuvo una media de 383.54 ± 67.96 ms vs. 1972.57 ± 3423.56 ms en el grupo P. 10 pacientes (25%) obtuvieron un TRNSC > 500 ms, de los cuales 100% requirieron marcapasos; de los 14 pacientes que requirieron marcapasos 10 (71.43%) tenían un TRNSC elevado (p ≤ 0.01). Conclusiones: El TRNSC tiene el potencial de ser una herramienta de pronóstico cuantitativo para la necesidad de futuros implantes de marcapasos en pacientes con disfunción del nodo sinusal, resultado de aleteo atrial pos-ablación. Esto podría ayudar a diagnosticar más temprano una disfunción del nodo sinusal, resultando en la reducción de la pérdida a largo plazo de la función cardíaca como efecto de la remodelación.

Adesão ao exercício físico e qualidade de vida de portadores de dispositivos cardíacos eletrônicos implantáveis / Adherence to physical exercise and quality of life of carriers of implantable deviceselectronic heart

Introdução: Dispositivos cardíacos eletrônicos implantáveis liberam estímulos elétricos para o músculo cardíaco quando este apresenta algum problema no sistema de condução. Objetivos: Verificar adesão à prática do exercício físico e correlacionar com a qualidade de vida de portadores de dispositivos cardíacos eletrônicos implantáveis. Métodos: Estudo transversal, quantitativo, descritivo, com correlação entre as variáveis, realizado no Ambulatório de Cardiologia de um hospital de ensino, com a participação de 70 portadores acompanhados pelo SUS . Foi desenvolvido por meio de um questionário com perguntas referentes à prática de exercício físico na rotina diária e seguindo a Versão Brasileira do Questionário de Qualidade de Vida-SF-36 que avalia os domínios: Capacidade funcional, Limitação por aspectos físicos, Dor, Estado geral de saúde, Vitalidade, Aspectos sociais, Limitação por aspectos emocionais e Saúde mental, no período de julho de 2021 a janeiro de 2022. Para análise estatística foram utilizados os métodos U de Mann - Whitney e correlação de Spearman. Resultados: Dos 70 portadores, 63, 2% não praticavam exercício físico regularmente, sendo a maior dificuldade os próprios problemas de saúde (48,90%), falta de interesse (17,80%), insegurança para praticar atividade física 35,7%, relataram não receber orientação por parte dos profissionais sobre esta questão 31,4%. As pontuações dos domínios foram: capacidade funcional (57,70), limitação por aspectos físicos (77,00), dor (71,75), estado geral de saúde (51,03), vitalidade (69,07), aspectos sociais (75,51), limitação por aspectos emocionais (83,23) e saúde mental (69,5), com média geral de 69,47, considerada de boa qualidade segundo os aspectos analisados. Dos que se exercitavam, constatou-se melhor qualidade de vida, visto que 92% relataram maior disposição para realizar as atividades diárias, 96% disseram que dormiam melhor, 92% disseram que ficavam doente com menor frequência e 92% que a interação social foi melhor com familiares e amigos. Conclusão: Os portadores de dispositivos cardíacos eletrônicos implantáveis, de forma geral, não aderem de forma satisfatória ao exercício físico, pois poucos praticam na sua rotina diária e a qualidade de vida foi considerada boa, de acordo com os domínios do SF-36. Entretanto, os que praticavam atividade física apresentaram maior pontuação de qualidade de vida em comparação com aqueles que não aderiram a essa prática.

Introduction: Implantable electronic cardiac devices release electrical stimuli to the heart muscle when there is a problem in the conduction system. Objectives: Verify adherence to physical exercise and correlate it with the quality of life of people with implantable electronic cardiac devices. Methods: Cross-sectional, quantitative, descriptive study, with correlation between variables, carried out in the cardiology outpatient clinic of a teaching hospital, with the participation of 70 patients monitored by the SUS. It was developed through a questionnaire with questions regarding the practice of physical exercise in the daily routine and following the Brazilian Version of the Quality of Life Questionnaire-SF-36 that evaluates the domains: Functional capacity, Limitation due to physical aspects, Pain, General health status, Vitality, Social aspects, Limitation due to emotional aspects and Health mental, from July 2021 to January 2022. For statistical analysis, the Mann U - Whitney and Spearman correlation methods were used. Results: Of the 70 patients, 63.2% did not practice physical exercise regularly, with the greatest difficulty being their own health problems (48.9%), lack of interest (17.8%), insecurity in practicing physical activity 35.7 %, reported not receiving guidance from professionals on this issue 31.4%. The domain scores were: functional capacity (57.70), limitation due to physical aspects (77.00), pain (71.75), general health status (51.03), vitality (69.07), social aspects (75.51), limitation due to emotional aspects (83.23) and mental health (69.5), with an overall average of 69.47, considered of good quality according to the aspects analyzed. Of those who exercised, there was a better quality of life, as 92% reported greater willingness to carry out daily activities, 96% said they slept better, 92% said they got sick less frequently and 92% said social interaction was better with family and friends. Conclusion: People with implantable electronic cardiac devices, in general, do not adhere satisfactorily to physical exercise, as few practices it in their daily routine and their quality of life was considered good, according to the SF-36 domains. However, those who practiced physical activity had higher quality of life scores compared to those who did not adhere to this practice.

Introducción: Los dispositivos cardíacos electrónicos implantables liberan estímulos eléctricos al músculo cardíaco cuando hay un problema en el sistema de conducción. Objetivos: Verificar la adherencia al ejercicio físico y correlacionarlo con la calidad de vida de personas portadoras de dispositivos cardíacos electrónicos implantables. Métodos: Estudio descriptivo, cuantitativo, transversal, con correlación entre variables, realizado en el ambulatorio de cardiología de un hospital universitario, con la participación de 70 pacientes acompañados por el SUS. Fue desarrollado a través de un cuestionario con preguntas sobre la práctica de ejercicio físico en la rutina diaria y siguiendo la Versión Brasileña del Cuestionario de Calidad de Vida-SF-36 que evalúa los dominios: Capacidad funcional, Limitación por aspectos físicos, Dolor, Estado de salud general, Vitalidad, Aspectos sociales, Limitación por aspectos emocionales y Salud mental, de julio de 2021 a enero de 2022. Para el análisis estadístico se utilizó el método de correlación Mann U - Whitney y Spearman. Resultados: De los 70 pacientes, el 63,2% no practicaba ejercicio físico regularmente, siendo la mayor dificultad sus propios problemas de salud (48,9%), desinterés (17,8%), inseguridad para practicar actividad física 35,7%, refirió no recibir orientación. de profesionales sobre este tema el 31,4%. Las puntuaciones de los dominios fueron: capacidad funcional (57,70), limitación por aspectos físicos (77,00), dolor (71,75), estado de salud general (51,03), vitalidad (69,07), aspectos sociales (75,51), limitación por aspectos emocionales (83,23) y salud mental (69,5), con una media global de 69,47, considerada de buena calidad dentro de los aspectos analizados. De quienes hacían ejercicio hubo una mejor calidad de vida, pues el 92% reportó mayor disposición para realizar las actividades diarias, el 96% dijo que dormía mejor, el 92% dijo que se enfermaba con menos frecuencia y el 92% dijo que la interacción social con familiares y amigos era mejor. Conclusión: Las personas con dispositivos cardíacos electrónicos implantables, en general, no adhieren satisfactoriamente al ejercicio físico, ya que pocos lo practican en su rutina diaria y su calidad de vida fue considerada buena, según los dominios del SF-36. Sin embargo, quienes practicaban actividad física presentaban puntuaciones más altas en calidad de vida en comparación con quienes no adherían a esa práctica.

Corrected sinus node recovery time as a screening test in patients with typical atrial flutter post-ablation to predict pacemaker implantation.

OBJECTIVE: The objective of the study was to establish the prognostic value of CSNRT regarding the necessity for pacemaker implantation in patients with atrial flutter (AFL) post-ablation. METHODS: This prospective cohort study, conducted at the National Institute of Cardiology "Ignacio Chavez" in Mexico City, assessed patients who had undergone ablation procedures to correct AFL, posterior to which an autonomic blockade was performed, and CSNRT was measured. RESULTS: The sample for this investigation was 40 patients. These were subdivided into two study groups depending on their requirement of pacemaker implant post-ablation (Pacemaker P, No Pacemaker NP). Sinus node (SN) dysfunction was diagnosed in 13 (32.5%) of the 40 participants, 10 (71.43%) of which required a pacemaker implant, while only 4 participants (28.57%) with normal SN function required pacemakers. Ten out of the 14 patients (71.43%) who required a pacemaker had an elevated CSNRT > 500 ms (p ≤ 0.01). Post-ablation CSNRT mean was 383.54 ms ± 67.96 ms in the NP group versus 1972.57 ms ± 3423.56 ms in the P group. Furthermore, SN pause in the P group had a mean of 1.86 s ± 0.96 s versus the NP group with 1.196 s ± 0.52 s. CONCLUSION: CSNRT has the potential to be a quantitative prognostic tool for the assessment of future pacemaker implants in patients with AFL post-ablation. This could aid in the timely diagnosis of sinus node dysfunction, which could, in the long run, result in the reduction of cardiac functional capacity loss due to cardiac remodeling.

OBJETIVO: Establecer el valor pronóstico del TRNSC basado en la necesidad de marcapasos en pacientes diagnosticados con aleteo atrial, pos-ablación. MÉTODOS: Este cohorte prospectivo, realizado en el Instituto Nacional de Cardiología "Ignacio Chávez" en la Ciudad de México, evaluó pacientes sometidos a ablación para corregir el aleteo atrial; se midió el TRNSC post bloqueo autonómico. RESULTADOS: La muestra de 40 pacientes se subdividió en 2 grupos según su requerimiento de marcapasos posterior a la ablación (P y NP). Se diagnosticó disfunción del nodo sinusal en 13 participantes (32.5%), de los cuales 10 (71.43%) requirieron marcapasos en comparación a 4 (28.57%) con función normal. En el grupo P la pausa del nodo sinusal post-ablación tuvo una media de 1.86 ± 0.96 s versus el grupo NP con 1.196 ± 0.52 s. En relación con el TRNSC, el grupo NP tuvo una media de 383.54 ± 67.96 ms vs. 1972.57 ± 3423.56 ms en el grupo P. 10 pacientes (25%) obtuvieron un TRNSC > 500 ms, de los cuales 100% requirieron marcapasos; de los 14 pacientes que requirieron marcapasos 10 (71.43%) tenían un TRNSC elevado (p ≤ 0.01). CONCLUSIONES: El TRNSC tiene el potencial de ser una herramienta de pronóstico cuantitativo para la necesidad de futuros implantes de marcapasos en pacientes con disfunción del nodo sinusal, resultado de aleteo atrial pos-ablación. Esto podría ayudar a diagnosticar más temprano una disfunción del nodo sinusal, resultando en la reducción de la pérdida a largo plazo de la función cardíaca como efecto de la remodelación.

Spanish pacemaker registry. 20th official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2022).

INTRODUCTION AND OBJECTIVES: This article reports the cardiac pacing activity performed in 2022, including the total number of implants, adherence to remote monitoring, demographic and clinical factors, and the characteristics of the implanted devices. METHODS: The information sources were the CardioDispositivos online platform, the European pacemaker patient identification card, and data provided by the manufacturers. RESULTS: The rates of conventional pacemakers and low-energy resynchronizers were 866 and 34 units per million population, respectively. A total of 815 leadless pacemakers were implanted. In all, 16426 procedures performed in 82 hospitals were reported (9407 through CardioDispositivos), representing 40% of the activity. The mean age was 78.6 years, with a predominance of men (60.3%). The most frequent disorder was atrioventricular block, and 14.5% of the patients had atrial fibrillation. There was a predominance of the DDD/R pacing mode (55.6%), and pacing mode was influenced by age, such that more than one-third of patients older than 80 years in sinus rhythm received single-chamber ventricular pacing. The remote monitoring program included 35% of conventional pacemakers and 55% of low-energy resynchronization pacemakers. CONCLUSIONS: The number of conventional pacemakers increased by 5.6%, low-energy resynchronizers by 16%, and leadless pacemakers by 25%. Adherence to remote monitoring was stable. The number of procedures included in CardioDispositivos increased by 11%, although the sample volume decreased. In the coming years, the widespread use of the platform will likely lead to a high-quality registry.

Seguridad del paciente en Resonancia Magnética / Patient safety in magnetic resonance imaging

El uso de campos magnéticos estáticos, gradientes de campo y ondas de radiofrecuencia suponen un reto de seguridad diferente a otras modalidades de imagen. Cada vez más centros trabajan con equipos de 3,0T que presentan mayores riesgos para el paciente frente a los de 1,5T. Hay una necesidad de actualización para el personal de radiología que le permita entender los riesgos y disminuirlos, pues pueden producirse incidentes graves e incluso mortales. El objetivo de este trabajo es presentar una revisión y actualización de los riesgos a los que se ven sometidos los pacientes durante la realización de un estudio de resonancia magnética.(AU)

Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging study.(AU)

Patient safety in magnetic resonance imaging.

Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging (MRI) study.

Riesgo arrítmico en episodios únicos o recurrentes de síncope inexplicado con bloqueo completo de rama / Arrhythmic risk in single or recurrent episodes of unexplained syncope with complete bundle branch block

Introducción y objetivos: Los pacientes con un episodio sincopal inexplicable único (ESU) y bloqueo completo de rama del haz de His (BcR) con frecuencia se tratan de manera más conservadora que aquellos con episodios recurrentes (ESR). El objetivo fue analizar si existen diferencias entre pacientes con ESU o ESR y BcR en cuanto al riesgo arrítmico, el rendimiento diagnóstico de las pruebas y los resultados clínicos. Métodos: Estudio de cohorte de pacientes consecutivos con seguimiento medio de 3 años. Fueron estudiados mediante un protocolo escalonado basado en un estudio electrofisiológico y seguimiento con un monitor cardiaco implantable (MCI). Resultados: De los 503 pacientes incluidos en el estudio, 238 (47,3%) referían un ESU. El riesgo de síncope arrítmico fue similar en ambos grupos (58,8% ESU frente a 57,0% ESR; p=0,68), también tras ajustar por variables de confusión (HR=1,06; IC95%, 0,81-1,38; p=0,674). No se encontraron diferencias significativas en cuanto a los resultados del estudio electrofisiológico y la rentabilidad diagnóstica del monitor cardiaco implantable. Un total de 141 (59,2%) pacientes con ESU y 154 (58,1%) con ESR requirieron el implante de un dispositivo cardiaco (p=0,797). Tras el tratamiento adecuado, 35 (7%) pacientes presentaron recurrencia del síncope. La tasa de recurrencia y la mortalidad también fueron similares. Conclusiones: Los pacientes con BcR y síncope tienen un alto riesgo de tener una etiología arrítmica, aunque solo hayan presentado un episodio aislado. Los pacientes con ESU y ESR tienen un riesgo arrítmico similar y presentan un pronóstico similar, por lo que no existe una justificación clínica para no tratarlos de la misma manera.(AU)

Introduction and objectives: Patients with a single syncopal episode (SSE) and complete bundle branch block (cBBB) are frequently managed more conservatively than patients with recurrent episodes (RSE). The objective of this study was to analyze if there are differences between patients with single or recurrent unexplained syncope and cBBB in arrhythmic risk, the diagnostic yield of tests, and clinical outcomes. Methods: Cohort study of consecutive patients with unexplained syncope and cBBB with a median follow-up time of 3 years. The patients were evaluated via a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor. Results: Of the 503 patients included in the study, 238 (47.3%) had had only 1 syncopal episode. The risk of an arrhythmic syncope was similar in both groups (58.8% in SSE vs 57.0% in RSE; P=.68), also after adjustment for possible confounding variables (HR, 1.06; 95%CI, 0.81-1.38; P=.674). No significant differences between the groups were found in the EPS results and implantable cardiac monitor diagnostic yield. A total of 141 (59.2%) patients with SSE and 154 (58.1%) patients with RSE required cardiac device implantation (P=.797). After appropriate treatment, 35 (7%) patients had recurrence of syncope. The recurrence rate and mortality were also similar in both groups. Conclusions: Patients with cBBB and unexplained syncope are at high risk of an arrhythmic etiology, even after the first syncopal episode. Patients with SSE and RSE have a similar arrhythmic risk and similar outcomes, and therefore there is no clinical justification for not managing them in the same manner.(AU)

Embolia pulmonar en endocarditis infecciosa asociada a marcapasos: reporte de un caso y revisión de la literatura

Introducción: Una de las complicaciones más temidas de la endocarditis infecciosa (EI) asociada a marcapasos es la embolia pulmonar. Presentamos el caso de una paciente con diagnóstico actual de EI asociada a marcapasos, que luego de la extracción del dispositivo por vía percutánea presentó síntomas de embolia pulmonar confirmada mediante estudios por imágenes. Objetivos: Conocer el manejo y la evolución intrahospitalarios y a los 18 meses de la embolia pulmonar en el contexto de una endocarditis infecciosa asociada a marcapasos. Materiales y métodos: Búsqueda bibliográfica efectuada en PubMed. Relato del caso clínico: evaluación clínica, presentación de los estudios complementarios y tratamiento. Seguimiento del caso. Resultados: Paciente de 68 años, sexo femenino, con antecedente de implantación de marcapaso definitivo bicameral hace 2 años. Síndrome febril prolongado sin foco aparente, con hemocultivos que fueron positivos para Staphylococcus aureus meticilino-resistente. En el ecocardiograma transesofágico presentaba múltiples vegetaciones en aurícula derecha asociadas con los catéteres. Con base en la anamnesis, el examen físico y los hallazgos en exámenes específicos, se pudo lograr el diagnóstico de EI asociada a marcapasos. Se indicó tratamiento antibiótico y la remoción completa percutánea del dispositivo. Luego del procedimiento presentó disnea súbita confirmándose mediante estudio de centellograma ventilación-perfusión el diagnóstico de embolia pulmonar. Completó el tratamiento antibiótico (vancomicina durante 6 semanas) y fue dada de alta. Durante el seguimiento no presentó nuevas infecciones u otras complicaciones. Conclusión: En nuestro caso, la embolia pulmonar no generó modificaciones en la morbimortalidad intrahospitalaria ni en el seguimiento a 18 meses.

Introduction: One of the most feared infective endocarditis (IE) complications associated with pacemaker is pulmonary embolism. We present the case of a patient with a current diagnosis of pacemaker-associated IE who presented symptoms of pulmonary embolism confirmed by imaging studies after percutaneous removal of the device. Objectives: to know the management and evolution, in-hospital and at 18 months of pulmonary embolism in the context of infective endocarditis associated with pacemaker. Materials and methods: Bibliographic search carried out in PubMed. Clinical case report: clinical evaluation, presentation of complementary studies, and treatment. Follow up on the case. Results: 68-year-old patient with a history of dual chamber permanent pacemaker implantation 2 years ago. Prolonged febrile syndrome with no apparent focus, with positive blood cultures for methicillin-resistant Staphylococcus aureus. The transesophageal echocardiogram showed multiple vegetations associated in right atrial with the catheters. Based on the history, physical examination, and findings in specific tests, the diagnosis of IE associated with DEIP could be achieved. Antibiotic treatment and complete percutaneous removal of the device were indicated. After the procedure, he presented sudden dyspnea, confirming the diagnosis of pulmonary embolism in a ventilation-perfusion scintigram study. She completed the antibiotic treatment (vancomycin for 6 weeks) and was discharged. During follow-up, there were no new infections or other complications. Conclusion: in our patient pulmonary embolism did not generate changes in in-hospital morbidity and mortality or in the 18-month follow-up.

Embolia pulmonar en endocarditis infecciosa asociada a marcapasos: reporte de un caso y revisión de la literatura / Pulmonary embolism in infective endocarditis associated with pacemaker: report of a case and review of the literature

Introducción: Una de las complicaciones más temidas de la endocarditis infecciosa (EI) asociada a marcapasos es la embolia pulmonar. Presentamos el caso de una paciente con diagnóstico actual de EI asociada a marcapasos, que luego de la extracción del dispositivo por vía percutánea presentó síntomas de embolia pulmonar confirmada mediante estudios por imágenes. Objetivos: Conocer el manejo y la evolución intrahospitalarios y a los 18 meses de la embolia pulmonar en el contexto de una endocarditis infecciosa asociada a marcapasos. Materiales y métodos: Búsqueda bibliográfica efectuada en PubMed. Relato del caso clínico: evaluación clínica, presentación de los estudios complementarios y tratamiento. Seguimiento del caso. Resultados: Paciente de 68 años, sexo femenino, con antecedente de implantación de marcapaso definitivo bicameral hace 2 años. Síndrome febril prolongado sin foco aparente, con hemocultivos que fueron positivos para Staphylococcus aureus meticilino-resistente. En el ecocardiograma transesofágico presentaba múltiples vegetaciones en aurícula derecha asociadas con los catéteres. Con base en la anamnesis, el examen físico y los hallazgos en exámenes específicos, se pudo lograr el diagnóstico de EI asociada a marcapasos. Se indicó tratamiento antibiótico y la remoción completa percutánea del dispositivo. Luego del procedimiento presentó disnea súbita confirmándose mediante estudio de centellograma ventilación-perfusión el diagnóstico de embolia pulmonar. Completó el tratamiento antibiótico (vancomicina durante 6 semanas) y fue dada de alta. Durante el seguimiento no presentó nuevas infecciones u otras complicaciones. Conclusión: En nuestro caso, la embolia pulmonar no generó modificaciones en la morbimortalidad intrahospitalaria ni en el seguimiento a 18 meses.

Introduction: One of the most feared infective endocarditis (IE) complications associated with pacemaker is pulmonary embolism. We present the case of a patient with a current diagnosis of pacemaker-associated IE who presented symptoms of pulmonary embolism confirmed by imaging studies after percutaneous removal of the device. Objectives: to know the management and evolution, in-hospital and at 18 months of pulmonary embolism in the context of infective endocarditis associated with pacemaker. Materials and methods: Bibliographic search carried out in PubMed. Clinical case report: clinical evaluation, presentation of complementary studies, and treatment. Follow up on the case. Results: 68-year-old patient with a history of dual chamber permanent pacemaker implantation 2 years ago. Prolonged febrile syndrome with no apparent focus, with positive blood cultures for methicillin-resistant Staphylococcus aureus. The transesophageal echocardiogram showed multiple vegetations associated in right atrial with the catheters. Based on the history, physical examination, and findings in specific tests, the diagnosis of IE associated with DEIP could be achieved. Antibiotic treatment and complete percutaneous removal of the device were indicated. After the procedure, he presented sudden dyspnea, confirming the diagnosis of pulmonary embolism in a ventilation-perfusion scintigram study. She completed the antibiotic treatment (vancomycin for 6 weeks) and was discharged. During follow-up, there were no new infections or other complications. Conclusion: in our patient pulmonary embolism did not generate changes in in-hospital morbidity and mortality or in the 18-month follow-up.

Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT / Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document

La resonancia magnética se ha convertido en técnica de imagen de primera línea en muchas situaciones clínicas. El número de pacientes portadores de dispositivos cardiovasculares, como los dispositivos cardiovasculares electrónicos implantables, ha crecido de modo exponencial. Aunque se han descrito complicaciones y efectos adversos cuando estos pacientes se someten a exploraciones de resonancia magnética, la evidencia clínica actual respalda la seguridad de realizar estos estudios cuando se cumplen unas normas y recomendaciones dirigidas a minimizar los posibles riesgos. El Grupo de Trabajo de Cardiorresonancia Magnética y Cardiotomografía Computarizadas de la Sociedad Española de Cardiología (SEC-GT CRMTC), la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (SEC-Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología), la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Imagen Cardiotorácica (SEICAT) han elaborado el presente documento, que revisa la evidencia disponible en este campo y establece las recomendaciones necesarias para que los pacientes portadores de dispositivos cardiovasculares electrónicos implantables y otros dispositivos puedan acceder con seguridad a este instrumento diagnóstico.(AU)

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.(AU)

Guía para identificar características específicas en dispositivos de estimulación cardiaca mediante figura radiológica / Guide to identify specific characteristics in cardiac pacing devices by radiological figure

Resumen Esta guía propone brindar una ayuda a todos los médicos para la identificación metódica de cada marca comercial de marcapasos por radiografía simple de tórax, por medio de sus componentes electrónicos (conectores de electrodos, circuito lógico y batería), siendo necesario para la interrogación de dispositivos de marcapasos posterior a su implante. Se describirán los diferentes tipos de marcapasos, electrodos y modos de programación más frecuentemente utilizados.

Abstract This guide provides help for medical doctors systematically identifying each commercial brand of pacemakers by thoracic radiography through their electronic components (electrode connectors, logic circuit, and battery); this is crucial for watching the pacemaker after being implanted. We aimed to describe the different cardiac stimulation devices, electrodes, and programming modes more frequently used.

Intervenção educativa de cuidados ao paciente portador de dispositivo cardíaco eletrônico implantável / Educational intervention for patient care with an implantable electronic heart device

Introdução: Entre os tratamentos atuais para controle de arritmias, os mais comuns são os dispositivos cardíacos eletrônicos implantáveis, capazes de controlar o ritmo do coração por meio de diferentes terapias, de acordo com as necessidades do paciente. Embora proporcionem maior longevidade às pessoas, a dependência de um dispositivo biomecânico geralmente exige mudança no estilo de vida do portador. Objetivos: Caracterizar o perfil sociográfico e clínico dos pacientes com dispositivos cardíacos eletrônicos implantáveis e identificar o conhecimento adquirido após intervenção educativa do enfermeiro. Material e Métodos: Pesquisa transversal, quantitativa, descritiva, com correlação entre as variáveis. Participaram 30 portadores de dispositivos, por meio de intervenção educativa do enfermeiro e uso de um folheto ilustrativo sobre cuidados pós-implante, disponibilizado ao paciente. Em seguida, foi realizada entrevista estruturada com questões referentes às orientações feitas sobre os cuidados. Resultados: A maioria dos participantes acertou todas as respostas sobre as recomendações de cuidados pós-operatórios de forma imediata. Quanto às orientações referentes ao tempo de repouso para voltar às atividades cotidianas, 28 (93,3%) acertaram; como proceder diante de detectores de metal 25 (83,3%) acertaram e sobre o uso de colchão magnético, 25 (83,3%) acertaram, demonstrando que estes conhecimentos precisam de maior esclarecimento. Conclusão: A intervenção educativa e o uso de folheto ilustrativo sobre cuidados pós-implante de dispositivos cardíacos implantáveis facilitou a explicação e propiciou a assimilação do conhecimento, sendo um recurso importante para o enfermeiro que atua na área cardiológica

Introduction: Among the current treatments for arrhythmias control, the most common are implantable electronic cardiac devices, capable of controlling the heart rhythm through different therapies, according to the needs of the patient. Although they provide greater longevity to people, dependence on a biomechanical device usually requires a change in the lifestyle of the carrier. Objectives: To characterize the sociographic and clinical profile of patients with implantable electronic cardiac devices and to identify the knowledge acquired after nurses' educational intervention. Material and Methods: Cross-sectional, quantitative, descriptive research, with correlation between variables. Thirty patients with devices participated, through the nurse's educational intervention and the use of an illustrative leaflet on post-implant care, made available to the patient. Then, a structured interview was conducted with questions regarding the guidelines made about care. Results: The majority of the participants answered all the recommendations for postoperative care immediately. Regarding the guidelines regarding rest time to return to daily activities, 28 (93.3%) agreed; how to proceed before metal detectors 25 (83.3%) agreed and on the use of magnetic mattress, 25 (83.3%) proved that this knowledge needs further clarification. Conclusion: The educational intervention and the use of illustrative leaflet on post-implantation care of implantable cardiac devices facilitated the explanation and provided the assimilation of knowledge, being an important resource for the nurse who works in the cardiological area

Introducción: Entre los tratamientos actuales para el control de la arritmia, los más comunes son los dispositivos cardíacos electrónicos implantables, capaces de controlar el ritmo cardíaco a través de diferentes terapias, según las necesidades del paciente. Si bien brindan a las personas una mayor longevidad, la dependencia de un dispositivo biomecánico suele requerir un cambio en el estilo de vida del usuario. Objetivos: Caracterizar el perfil sociográfico y clínico de pacientes portadores de dispositivos cardíacos electrónicos implantables e identificar los conocimientos adquiridos después de una intervención educativa por parte de enfermeros. Material y Métodos: Investigación transversal, cuantitativa, descriptiva, con correlación entre variables. Participaron 30 portadores de dispositivos, a través de una intervención educativa por parte de enfermeras y el uso de un tríptico ilustrativo sobre los cuidados post-implante, a disposición del paciente. Luego, se realizó una entrevista estructurada con preguntas sobre las pautas dadas sobre el cuidado. Resultados: La mayoría de los participantes acertaron en todas las recomendaciones de cuidados postoperatorios inmediatos. En cuanto a las orientaciones sobre el tiempo de descanso para la reincorporación a las actividades cotidianas, 28 (93,3%) fueron correctas; cómo proceder frente a los detectores de metales 25 (83,3%) fueron correctos y sobre el uso de un colchón magnético, 25 (83,3%) fueron correctos, lo que demuestra que este conocimiento necesita mayor aclaración. Conclusión: La intervención educativa y el uso de un tríptico ilustrativo sobre cuidados post-implante de dispositivos cardíacos implantables facilitó la explicación y facilitó la asimilación de conocimientos, siendo un recurso importante para los enfermeros que actúan en el área de cardiología