The RITHMI study: diagnostic ability of a heart rhythm monitor for automatic detection of atrial fibrillation.

INTRODUCTION AND OBJECTIVES: Early detection of atrial fibrillation (AF) is a priority to reduce embolic events by initiating oral anticoagulation therapy. The aim of this study was to evaluate the diagnostic ability of a wrist device designed for automatic AF detection. METHODS: RITHMI is a prospective, comparative, observational study that included 167 patients referred to a cardiology outpatient clinic for a general consultation or for electrical cardioversion. The study evaluated the ability of a wrist monitor that uses a photoplethysmography (PPG) signal and an electrocardiographic lead to automatically detect AF compared with diagnosis established by 2 cardiologists using the 12-lead electrocardiogram. RESULTS: The AF detection algorithm based on the PPG signal had a sensitivity of 91% and a specificity of 96% (diagnostic accuracy: 93%). The automatic algorithm based on the electrocardiographic signal had a sensitivity of 94% and a specificity of 96% (diagnostic accuracy: 95%). The 2 algorithms concurred in the diagnosis in 96% of the cases. Overall, the monitor had a sensitivity and specificity of 95% (diagnostic accuracy: 95% and Kappa index: 0.98). CONCLUSIONS: This study shows that automatic AF detection through the use of a heart rhythm monitor incorporating sensors and algorithms that analyze the PPG signal and the electrocardiographic signal corresponding to lead I is feasible and has high diagnostic accuracy.

Selección de lo mejor del año 2017 en estimulación cardiaca: resonancia magnética en pacientes portadores de marcapasos y desfibriladores / Selection of the best of 2017 on cardiac pacing: magnetic resonance in patients with pacemaker and implantable defibrillator

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Mejoría hemodinámica y de la contractilidad con la estimulación multipunto del ventrículo izquierdo en la terapia de resincronización cardiaca / Improvement in Hemodynamics and Contractility With Multipoint Left Ventricular Pacing in Cardiac Resynchronization Therapy

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Registro Español de Marcapasos. IX Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2011) / Spanish Pacemaker Registry. Ninth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2011)

Introducción y objetivos. Se describe el resultado del análisis de la actividad con marcapasos remitidos en 2011 al Registro Español de Marcapasos, con especial referencia a la distribución poblacional y la selección de los modos de estimulación. Métodos. Procesado de la información de la Tarjeta Europea del Paciente Portador de Marcapasos con una aplicación informática específica. Resultados. Se analiza la información de 115 centros hospitalarios, un total de 13.373 tarjetas, lo que corresponde al 38% de la actividad estimada. El consumo de generadores convencionales y dispositivos de resincronización fue de 738 y 56,2 unidades por millón habitantes, respectivamente. La media de edad de los pacientes que recibieron un implante fue 76,7 años. El 57,2% de los implantes y el 56,5% de los recambios se realizaron en varones. La mayoría de los implantes (38,7%) y recambios de generadores (41,9%) se produjeron en la franja de 80-89 años. El 99,7% de los cables utilizados eran bipolares; el 63%, con sistema de fijación activa. A más del 20% de los pacientes con bloqueo auriculoventricular o enfermedad del nódulo sinusal se los estimula en modo VVI/R pese a estar en ritmo sinusal. Conclusiones. Respecto a años previos, se ha estabilizado el uso de marcapasos convencionales y han aumentado los implantes de resincronizadores. Persiste la mayor incidencia de implantes en los varones y a menor edad. La edad y el grado de bloqueo se muestran influyentes en la adecuación del modo de estimulación (AU)

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 (AU)

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.

Análisis transversal de la resincronización cardiaca en España. Indicaciones, técnicas de implante, optimización y seguimiento / Cross-sectional study of cardiac resynchronization therapy in Spain. Indications, implant techniques, optimization and follow-up

Introducción y objetivos. Realizar un estudio transversal de la terapia de resincronización cardiaca en España, analizando los problemas en las indicaciones, el implante y el seguimiento del paciente. Métodos. Identificar los centros españoles que realizan implantes de resincronización solicitando un cuestionario (septiembre de 2010 a septiembre de 2011) a cada equipo. Resultados. Se identificó un total de 88 centros, de los que 85 (96,6%) cumplimentaron la hoja de recogida de datos. El número de implantes de resincronizador (marcapasos o desfibriladores) fue de 2.147 (el 85,6% del total estimado de 2.518 por la European Confederation of Medical Suppliers Associations en ese periodo). El número de implantes/millón de habitantes comunicados fue 46 y el estimado, 54 (media en Europa, 131). Los implantes/recambios de resincronizador suponen el 84% y las mejoras del modo de estimulación upgrade de dispositivos previos, un 16%. La mayor parte de los resincronizadores se implantaron en varones (70,7%), con medias de edad de 68±12 años y de fracción de eyección ventricular izquierda del 26,4±5%. La mayoría de los pacientes (67%) estaban en clase funcional III de la New York Heart Association. El grupo de pacientes con nueva indicación según la última actualización de guías es ya significativo, con el 17,3% entre los pacientes en clase II y el 21,6% de los pacientes con fibrilación auricular. El 73,8% de los implantadores son electrofisiólogos, seguidos por los cirujanos (21,4%). Conclusiones. Las nuevas indicaciones recomendadas se están implantando progresivamente según los datos obtenidos en pacientes en clase II o fibrilación auricular. Sin embargo, el número de implantes de resincronizador en España aún está lejos de la media europea (AU)

Introduction and objectives. A cross-sectional study of cardiac resynchronization therapy use in Spain was performed to analyze problems with indications, implantation, and patient follow-up. Methods. Spanish cardiac resynchronization therapy implanter centers were identified, then the department members were surveyed and the data were recorded by each implantation team. Results. Eighty-eight implanter centers were identified; of these, 85 (96.6%) answered the survey. A total of 2147 device implantations were reported, comprising 85.6% of the overall number of 2518 implantations estimated by the European Confederation of Medical Suppliers Associations for the same period. The reported implantation rate was 46 per million inhabitants versus an estimated implantation rate of 51 per million (European average, 131). Cardiac resynchronization therapy devices accounted for 84% of implantations, and upgrades to previously implanted devices, 16%. The majority of cardiac resynchronization therapy devices were implanted in men (70.7%). The mean age was 68 (12) years, and the mean left ventricular ejection fraction was 26.4% (5%). Most patients (67%) were in New York Heart Association functional class III. The group of patients for whom cardiac resynchronization therapy was indicated according to the latest update of the guidelines was significant: 17.3% among New York Heart Association class II patients and more than 21.6% among patients with atrial fibrillation. In all, electrophysiologists accounted for 73.8% of implanters, followed by surgeons, accounting for 21.4%. Conclusions. The latest update of the guidelines is being progressively implemented in Spain, according to data obtained in patients in New York Heart Association class II or with atrial fibrillation. Nevertheless, the number of cardiac resynchronization therapy device implants is still well below the European average (AU)

Cross-sectional study of cardiac resynchronization therapy in Spain. Indications, implant techniques, optimization and follow-up.

INTRODUCTION AND OBJECTIVES: A cross-sectional study of cardiac resynchronization therapy use in Spain was performed to analyze problems with indications, implantation, and patient follow-up. METHODS: Spanish cardiac resynchronization therapy implanter centers were identified, then the department members were surveyed and the data were recorded by each implantation team. RESULTS: Eighty-eight implanter centers were identified; of these, 85 (96.6%) answered the survey. A total of 2147 device implantations were reported, comprising 85.6% of the overall number of 2518 implantations estimated by the European Confederation of Medical Suppliers Associations for the same period. The reported implantation rate was 46 per million inhabitants versus an estimated implantation rate of 51 per million (European average, 131). Cardiac resynchronization therapy devices accounted for 84% of implantations, and upgrades to previously implanted devices, 16%. The majority of cardiac resynchronization therapy devices were implanted in men (70.7%). The mean age was 68 (12) years, and the mean left ventricular ejection fraction was 26.4% (5%). Most patients (67%) were in New York Heart Association functional class III. The group of patients for whom cardiac resynchronization therapy was indicated according to the latest update of the guidelines was significant: 17.3% among New York Heart Association class II patients and more than 21.6% among patients with atrial fibrillation. In all, electrophysiologists accounted for 73.8% of implanters, followed by surgeons, accounting for 21.4%. CONCLUSIONS: The latest update of the guidelines is being progressively implemented in Spain, according to data obtained in patients in New York Heart Association class II or with atrial fibrillation. Nevertheless, the number of cardiac resynchronization therapy device implants is still well below the European average.

Ischemic time as a predictor of physical recovery in the first months after heart transplantation.

Functional results after heart transplantation range from modest to spectacular improvement. Little is known about factors to predict functional result. This study aimed to identify these factors. We present a prospective study including all consecutive transplant recipients (n = 55) in a two-year period whose survival was greater than two months. Perioperative, donor, and recipient issues were systematically analyzed. Exercise capacity was assessed by symptom-limited treadmill exercise testing two months after transplantation. Exercise capacity was classified as satisfactory or poor depending on achieving or not 4.5 METs (metabolic equivalents), respectively. Thirty-three patients (60%) showed a good exercise capacity (>4.5 METs), whereas the remaining twenty-two patients (40%) were unable to exceed this threshold. The variables which correlated with exercise capacity in univariate analysis were recipient age, inotropic treatment, ischemic time, ventricular assist device, etiology, urgent transplant, and INTERMACS score. Among them only recipient age and ischemic time were proved to be correlated with exercise capacity in the multiple regression analysis. Thus, younger patients and those who had received an organ with shorter ischemic time showed greater exercise capacity after transplant. These findings strengthen the trend toward reducing ischemic time as much as possible to improve both survival and clinical recovery.

Novedades en estimulación cardiaca / Advances in cardiac pacing

Este artículo revisa el estado actual de la monitorización y el seguimiento a distancia de dispositivos de estimulación cardiaca y los aspectos más novedosos de la terapia de resincronización cardiaca. Asimismo, se resumen los artículos más relevantes publicados en el último año (AU)

This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed (AU)

Registro Español de Marcapasos. VIII Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2010) / Spanish Pacemaker Registry. Eighth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2010)

Introducción y objetivos. En este artículo se describe el análisis de los implantes y recambios de marcapasos remitidos al Registro Español de Marcapasos en 2010, con especial referencia a la selección de los modos de estimulación. Métodos. La recogida de datos se basa en la información de la Tarjeta Europea del Paciente Portador de Marcapasos, que se procesa mediante una aplicación informática específica. Resultados. Se recibió información de 101 centros hospitalarios, con un total de 11.648 tarjetas. Se estima un consumo de 738 generadores por millón de habitantes. Entre los varones hay mayor incidencia de implantes de marcapasos y a una media de edad más baja. El 95,5% de los cables de estimulación utilizados fueron bipolares, el 56% con sistema de fijación activa y el 60% en cavidad auricular. La indicación electrocardiográfica más frecuente es el bloqueo auriculoventricular, seguida de la enfermedad del nódulo sinusal. El 24% de los pacientes con bloqueo auriculoventricular y el 25,6% con enfermedad del nódulo sinusal se estimulan en modo VVI/R (el 12% de unos y otros entre los pacientes de 80 o menos años). Los dispositivos de resincronización cardiaca alcanzan 47 unidades por millón de habitantes; un 25,7% no tiene desfibrilador automático implantable asociado. Conclusiones. Persiste el aumento del consumo de generadores de marcapasos. Los cables de estimulación que se utilizan son bipolares, y en su mayoría son de fijación activa. La edad sigue siendo un factor influyente en la adecuación del modo de estimulación en las diversas afecciones. La elección del modo de estimulación se puede mejorar en más del 20% (AU)

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 (AU)

[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.

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

This article contains a discussion of the most recent developments in cardiac resynchronization therapy, of the feasibility of performing magnetic resonance imaging in patients with cardiac pacemakers, and of the current and future status of leadless pacing. Finally, the most significant scientific articles published in the last year are reviewed.

Avances en estimulación cardiaca / Progress in cardiac pacing

Este artículo revisa los aspectos más novedosos de la terapia de resincronización cardiaca, la posibilidad de realizar resonancia magnética en pacientes con dispositivos de estimulación cardiaca y el estado actual y el futuro de la estimulación sin cables. Finalmente, se resumen los artículos científicos más relevantes publicados en el último año (AU)

This article contains a discussion of the most recent developments in cardiac resynchronization therapy, of the feasibility of performing magnetic resonance imaging in patients with cardiac pacemakers, and of the current and future status of leadless pacing. Finally, the most significant scientific articles published in the last year are reviewed (AU)

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.

Registro Español de Marcapasos. VII Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2009) / Spanish Pacemaker Registry. Seventh Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2009)

Introducción y objetivos. Se describe el análisis de los implantes de marcapasos remitidos al Registro Español de Marcapasos de 2009, con especial referencia a la distribución poblacional y la selección de los modos de estimulación en las diversas indicaciones electrocardiográficas. Métodos. Procesamiento de la información aportada por la Tarjeta Europea del Paciente Portador de Marcapasos en sus diversos campos empleando una aplicación informática específica. Resultados. Se recibió información de 106 centros, con un total de 11.939 tarjetas, el 35% de todos los marcapasos implantados. La media de edad del paciente que recibió el implante era 76,6 años. El 58,4% de los implantes se hicieron en varones. El mayor número de las indicaciones electrocardiográficas de los implantes fueron los bloqueos auriculoventriculares de tercer grado; los bloqueos auriculoventriculares fueron el 56%. Se estimuló en modo VVI/R al 24% de los pacientes con enfermedad del nódulo sinusal y el 23,5% de aquellos con bloqueos auriculoventriculares. Los cables utilizados fueron bipolares y más del 50% con sistema de fijación activa, el 65% en la posición auricular. Conclusiones. En 2009 persiste la tendencia al aumento del consumo de generadores de marcapasos (729/millón de habitantes), con mayor incidencia en los varones y a una edad ligeramente inferior que en las mujeres. El factor edad es más determinante que la alteración electrocardiográfica en la inadecuada selección del modo de estimulación. La elección de fijación activa de los cables supera el 50% (AU)

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 (AU)

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

This review discusses the utility and current status of remote monitoring in patients with cardiac devices in Spain, the different anticoagulation strategies used during device implantation, the surgical replacement and maintenance of pacemakers and defibrillators, and the present and future importance of impedance sensors in cardiac pacing and heart failure management. Finally, there is a summary of the most relevant scientific articles published in the last year.

Novedades en estimulación cardiaca / Progress in cardiac pacing

Se revisa la utilidad y el estado actual de la monitorización domiciliaria de pacientes con dispositivos en España, las diferentes estrategias de anticoagulación durante el implante, el recambio o la revisión quirúrgica de marcapasos o desfibriladores y la utilidad presente y futura de los sensores de impedancia en estimulación cardiaca y tratamiento de insuficiencia cardiaca. Finalmente se resumen los artículos científicos más relevantes publicados en el último año (AU)

This review discusses the utility and current status of remote monitoring in patients with cardiac devices in Spain, the different anticoagulation strategies used during device implantation, the surgical replacement and maintenance of pacemakers and defibrillators, and the present and future importance of impedance sensors in cardiac pacing and heart failure management. Finally, there is a summary of the most relevant scientific articles published in the last year (AU)

Registro Español de Marcapasos. VI Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2008) / Spanish Pacemaker Registry. 6th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2008)

Introducción y objetivos. En este artículo se describe el resultado del análisis de los implantes y recambios de marcapasos remitidos en 2008 al Registro Español de Marcapasos. Métodos. La recogida de datos se basa en la información de la Tarjeta Europea del Paciente Portador de Marcapasos. Resultados. Se recibió información de 116 centros hospitalarios, con un total de 11.855 tarjetas que suponen el 36,3% de los marcapasos implantados. Se objetiva un notable aumento del número de unidades consumidas, alcanzando 708,3 por millón de habitantes. Existe una mayor incidencia de implantes de marcapasos y a una media de edad más baja en varones, correspondiendo a la década de los setenta el mayor número de implantes, con el 39,1% del total. Los bloqueos auriculoventriculares aparecen como la más frecuente de las indicaciones electrocardiográficas. En los cables utilizados, el empleo del sistema de fijación activa supone el 59,3% de los auriculares y el 37% de los ventriculares. Se observa una mejor selección del modo de estimulación, siendo la edad un factor determinante, como por ejemplo en la enfermedad del nódulo sinusal, en la que se utiliza el modo VVI/R en el 29% de pacientes mayores de 80 años frente al 14% en los de edad inferior. Conclusiones. La edad es un factor que se muestra influyente en la adecuación del modo de estimulación. Aumenta la selección del sistema de fijación activa, alcanzando el 44,5% de los cables utilizados. La estimulación auriculoventricular registra el más alto porcentaje de utilización de todos los años analizados (AU)

Introduction and objectives. This article describes the findings of an analysis of data on pacemaker implantations and replacements reported to the Spanish Pacemaker Registry during 2008. Methods. The data came primarily from information recorded on European Pacemaker Patient Identification Cards. Results. Data were received from 116 hospital units, which submitted a total of 11,855 identification cards representing 36.3% of all pacemakers implanted. There was a marked increase in the number of pacemaker units used, which rose to a rate of 708.3 per million inhabitants. The frequency of pacemaker implantation increased and the mean age of male patients decreased. The largest number of implantations were carried out in patients in their 70s, who comprised 39.1% of the total. The most frequent electrocardiographic indication was atrioventricular block. With regard to pacing leads, active fixation leads were used in the atrium in 59.3% of cases and in the ventricle in 37.9% of cases. There was an improvement in the choice of pacing mode, with age being a determining factor. For example, in sick sinus syndrome, the VVI/R mode was used in a 29% of patients aged over 80 years compared with 14% of those aged under 80 years. Conclusions. Age was found to be one factor influencing the selection of the most appropriate pacing mode. Active fixation leads were used more often, reaching 44.5% of leads implanted. Atrioventricular pacing was used in a greater percentage of cases than in any other time period covered by the pacemaker registry (AU)