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Katritsis DG, Calkins H. Septal and Conduction System Pacing. Arrhythm Electrophysiol Rev 2023; 12:e25. [PMID: 37860698 PMCID: PMC10583155 DOI: 10.15420/aer.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023] Open
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Santos H, Figueiredo M, Paula SB, Santos M, Osório P, Portugal G, Valente B, Lousinha A, Silva Cunha P, Oliveira M. Apical or Septal Right Ventricular Location in Patients Receiving Defibrillation Leads: A Systematic Review and Meta-Analysis. Cardiol Rev 2023; Publish Ahead of Print:00045415-990000000-00080. [PMID: 36883833 DOI: 10.1097/crd.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
This study reviews the published data comparing the efficacy and safety of apical and septal right ventricle defibrillator lead positioning at 1-year follow-up. Systemic research on Medline (PubMed), ClinicalTrials.gov, and Embase was performed using the keywords "septal defibrillation," "apical defibrillation," "site defibrillation," and "defibrillation lead placement," including implantable cardioverter-defibrillator and cardiac resynchronization therapy devices. Comparisons between apical and septal position were performed regarding R-wave amplitude, pacing threshold at a pulse width of 0.5 ms, pacing and shock lead impedance, suboptimal lead performance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter, readmissions due to heart failure and mortality rates. A total of 5 studies comprising 1438 patients were included in the analysis. Mean age was 64.5 years, 76.9% were male, with a median LVEF of 27.8%, ischemic etiology in 51.1%, and a mean follow-up period of 26.5 months. The apical lead placement was performed in 743 patients and septal lead placement in 690 patients. Comparing the 2 placement sites, no significant differences were found regarding R-wave amplitude, lead impedance, suboptimal lead performance, LVEF, left ventricular end-diastolic diameter, and mortality rate at 1-year follow-up. Pacing threshold values favored septal defibrillator lead placement (P = 0.003), as well as shock impedance (P = 0.009) and readmissions due to heart failure (P = 0.02). Among patients receiving a defibrillator lead, only pacing threshold, shock lead impedance, and readmission due to heart failure showed results favoring septal lead placement. Therefore, generally, the right ventricle lead placement does not appear to be of major importance.
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Affiliation(s)
- Helder Santos
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
- Department of Cardiology, Centro Hospitalar Barreiro- Montijo, Barreiro, Portugal
| | - Margarida Figueiredo
- Department of Cardiology, Centro Hospitalar Barreiro- Montijo, Barreiro, Portugal
| | - Sofia B Paula
- Department of Cardiology, Centro Hospitalar Barreiro- Montijo, Barreiro, Portugal
| | - Mariana Santos
- Department of Cardiology, Centro Hospitalar Barreiro- Montijo, Barreiro, Portugal
| | - Paulo Osório
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Guilherme Portugal
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Bruno Valente
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Ana Lousinha
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Pedro Silva Cunha
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
| | - Mário Oliveira
- From the Department of Cardiology, Centro Hospitalar de Lisboa Central - Hospital Santa Marta, Lisbon, Portugal
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Osiecki A, Kochman W, Witte KK, Mańczak M, Olszewski R, Michałkiewicz D. Cardiomyopathy Associated with Right Ventricular Apical Pacing-Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11236889. [PMID: 36498462 PMCID: PMC9736505 DOI: 10.3390/jcm11236889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF). METHODS we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. RESULTS 14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80-4.91). CONCLUSION our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function.
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Affiliation(s)
- Andrzej Osiecki
- Department of Cardiovascular Diseases, Bielanski Hospital, Centre of Postgraduate Medical Education, Ceglowska 80 Street, 01-809 Warsaw, Poland
- Correspondence: ; Tel.: +48-604138896
| | - Wacław Kochman
- Department of Cardiovascular Diseases, Bielanski Hospital, Centre of Postgraduate Medical Education, Ceglowska 80 Street, 01-809 Warsaw, Poland
| | - Klaus K. Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Małgorzata Mańczak
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences in Warsaw, 5B Pawinskiego Street, 02-106 Warsaw, Poland
| | - Dariusz Michałkiewicz
- Department of Cardiovascular Diseases, Bielanski Hospital, Centre of Postgraduate Medical Education, Ceglowska 80 Street, 01-809 Warsaw, Poland
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Katritsis DG. Simple is Complicated. Arrhythm Electrophysiol Rev 2021; 10:131. [PMID: 34777815 PMCID: PMC8576484 DOI: 10.15420/aer.2021.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Demosthenes G Katritsis
- Editor-in-Chief, Arrhythmia & Electrophysiology Review Hygeia Hospital, Athens, Greece Johns Hopkins School of Medicine, Baltimore, MD, US
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Bongiorni MG, Della Tommasina V, Barletta V, Di Cori A, Rogani S, Viani S, Segreti L, Paperini L, Soldati E, De Lucia R, Zucchelli G. Feasibility and long-term effectiveness of a non-apical Micra pacemaker implantation in a referral centre for lead extraction. Europace 2020; 21:114-120. [PMID: 29893837 DOI: 10.1093/europace/euy116] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/20/2018] [Indexed: 11/12/2022] Open
Abstract
Aims To demonstrate the feasibility and long-term performances of a non-apical Micra pacemaker implantation. Methods and results Fifty-two consecutive patients underwent Micra implantation, targeting a non-apical site of delivery when feasible. Each patient received a regular follow-up (mean 13 ± 9 months). The first 17 patients were also enrolled in the Micra transcatheter pacing system trial (Group 1); the remaining ones presented broader indications and included post-extraction subjects (Group 2). In 19 of 52 patients (Group 1: 6%, Group 2: 51%; P = 0.002) Micra was implanted because of high-risk characteristics that discouraged the implantation of a traditional pacemaker. In 31 of 52 patients (60%) Micra was implanted in a non-apical location, with a lower rate of single delivery compared with apical sites (48% vs. 81%, P = 0.035), but without any impact on electrical performance. Pacing threshold remained optimal in the majority of patients (94%), regardless of the site of implantation (apical vs. non-apical location: 0.50 vs. 0.52 V/0.24 ms; P = 0.856) and group membership, with only 6% of the subjects showing elevated values (mean 1.92 ± 0.92 V/0.24 ms) at the last follow-up. No device-related adverse events were registered. Conclusion Micra pacemaker implant is a safe and effective procedure even in a real life cohort of high-risk patients. A non-apical site of implantation is feasible in the majority of patients allowing stable electrical performance at long-term follow-up.
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Affiliation(s)
- Maria Grazia Bongiorni
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Veronica Della Tommasina
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Valentina Barletta
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Andrea Di Cori
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Sara Rogani
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Stefano Viani
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Luca Segreti
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Luca Paperini
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Ezio Soldati
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Raffaele De Lucia
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Giulio Zucchelli
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
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Kaye G. The desire for physiological pacing: Are we there yet? J Cardiovasc Electrophysiol 2019; 30:3025-3038. [DOI: 10.1111/jce.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Gerry Kaye
- University of Queensland Medical School, Herston Brisbane Queensland Australia
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7
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Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Ann Biomed Eng 2019; 48:26-46. [DOI: 10.1007/s10439-019-02376-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 01/29/2023]
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Witt CM, Cha YM. Cardiac Resynchronization Therapy in Preserved to Mildly Reduced Systolic Function. Card Electrophysiol Clin 2019; 11:141-146. [PMID: 30717846 DOI: 10.1016/j.ccep.2018.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cardiac resynchronization therapy has been proven to be clearly beneficial for patients with heart failure, a prolonged QRS duration, and a left ventricular ejection fraction ≤35%. Ejection fraction cutoff, however, is arbitrary and very likely excludes many patients who could benefit from cardiac resynchronization. This article describes the major detrimental effects of left bundle branch block and summarizes the data regarding the potential beneficial effects of cardiac resynchronization in patients with a left ventricular ejection fraction greater than 35%.
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Affiliation(s)
- Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Suzuki T, Fujino T, Shinohara M, Koike H, Kinoshita T, Yuzawa H, Ikeda T. Right Ventricular Septal Pacing Using a Thin Lumenless Pacing Lead and Delivery System with a Deflectable Catheter. Int Heart J 2018; 59:1253-1260. [DOI: 10.1536/ihj.17-526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takeya Suzuki
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Masaya Shinohara
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Hideki Koike
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Hitomi Yuzawa
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
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Paton MF, Witte KK. Heart failure and right ventricular pacing - how to avoid the need for cardiac resynchronization therapy. Expert Rev Med Devices 2018; 16:35-43. [PMID: 30477355 DOI: 10.1080/17434440.2019.1552133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Heart failure (HF) is a common finding in patients with pacemakers implanted for bradycardia, with cross-sectional and longitudinal studies contributing to the growing consensus that right ventricular pacing can cause adverse cardiac remodeling and left ventricular systolic dysfunction increasing the risk of hospitalization and death. An unselected approach using cardiac resynchronization therapy from the time of first implant in patients with heart block has produced equivocal results. Contemporary research has therefore begun to focus on the stratification of patients' risk of pacemaker-associated impairment to permit focused, personalized management. AREAS COVERED The present review will describe the incidence and relevance of HF in the pacemaker population and discuss current management options for such patients. EXPERT COMMENTARY At present there are few contemporary data to guide the identification of patients with and at risk of pacemaker-associated cardiac remodeling and dysfunction. Emphasis must be placed on precise and personalized treatment approaches which currently remain under-investigated due to a number of challenges, for example, small sample sizes, limited clarity on programmed settings, and short follow-up periods.
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Affiliation(s)
- Maria F Paton
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
| | - Klaus K Witte
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
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Zhuang L, Mao Y, Wu L, Niu W, Chen K. Effects of right ventricular septum or His-bundle pacing versus right ventricular apical pacing on cardiac function: A systematic review and meta-analysis of randomized controlled trials. J Int Med Res 2018; 46:3848-3860. [PMID: 29962274 PMCID: PMC6136004 DOI: 10.1177/0300060518781415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective Recent studies have demonstrated that right ventricular apical
(RVA) pacing has a deleterious impact on left ventricular
function, while right ventricular septum (RVS) or His-bundle
pacing (HBP) contribute to improvements in cardiac function. A
meta-analysis of randomized controlled trials (RCTs) was
conducted to compare the mid- and long-term effects of RVS and
HB pacing versus RVA pacing on cardiac function. Methods Eligible RCTs were identified by systematically searching the
electronic literature databases PubMed®, Cochrane Library,
Embase® and Ovid®. Results Seventeen articles (n = 1290 patients) were
included in this meta-analysis, including 14 studies comparing
the effects of RVA and RVS pacing on cardiac function and three
studies comparing HBP with pacing at other sites. Compared with
RVA pacing, RVS or HBP exhibited a higher left ventricular
ejection fraction (LVEF) (weighted mean difference 3.28; 95%
confidence interval 1.45, 5.12) at the end of follow-up. Conclusions RVS pacing exhibited a higher LVEF after long-term follow-up than
RVA pacing. RVS pacing could replace the previously used RVA
pacing as a better alternative with improved clinical outcomes.
However, there remains a need for larger RCTs to compare the
safety and efficacy of RVS with RVA pacing.
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Affiliation(s)
- Lingfang Zhuang
- 1 Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ye Mao
- 2 Outpatient Department, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- 1 Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenquan Niu
- 3 Shanghai Institute of Hypertension, Shanghai, China
| | - Kang Chen
- 1 Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Kaye G, Ng JY, Ahmed S, Valencia D, Harrop D, Ng ACT. The Prevalence of Pacing-Induced Cardiomyopathy (PICM) in Patients With Long Term Right Ventricular Pacing - Is it a Matter Of Definition? Heart Lung Circ 2018; 28:1027-1033. [PMID: 30017634 DOI: 10.1016/j.hlc.2018.05.196] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/25/2018] [Accepted: 05/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Chronic right ventricular pacing may contribute to deterioration in left ventricular ejection fraction (LVEF). The aim of the study was to identify the prevalence of pacing-induced cardiomyopathy (PICM) in patients with chronic right ventricular pacing. METHODS Patients attending a pacemaker clinic were retrospectively identified as having had transthoracic echocardiographic LVEF measurement during the 12 months prior to device implantation. Those with cardioverter-defibrillators or biventricular devices were excluded. The remaining patients were invited back for a repeat echocardiogram. Three (3) different definitions of PICM were employed: 1) follow-up LVEF of ≤40% if baseline LVEF was ≥50%, or an absolute reduction in LVEF ≥5% if baseline LVEF was <50%; 2) follow-up LVEF of ≤40% if baseline LVEF was ≥50%, or an absolute reduction in LVEF ≥10% if baseline LVEF was ≤50%; 3) absolute reduction in LVEF ≥10% irrespective of baseline LVEF. Alternate causes of cardiomyopathy were excluded following a chart review. RESULTS The study cohort of 118 included 67 males (mean age 77.8±10.5years) and 51 females (mean age 76.8±11.2years). The mean time between baseline and follow-up echocardiograms was 3.5+1.4years (range 1.5-6.4 years). The prevalence of PICM ranged from 5.9 to 39.0% depending on PICM definition. Multivariate analysis found that PICM was significantly associated with ventricular pacing burden (p=0.013). CONCLUSIONS The prevalence of pacing induced cardiomyopathy is dependent on current accepted clinical definitions. A clear definition of PICM is required for a better understanding of the clinical implications of right ventricular pacing.
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Affiliation(s)
- Gerald Kaye
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; The University of Queensland, Faculty of Medicine, Brisbane, Qld, Australia.
| | - Jun Yen Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Shameer Ahmed
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Diana Valencia
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Danielle Harrop
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; The University of Queensland, Faculty of Medicine, Brisbane, Qld, Australia; The University of Queensland, Centre for Advanced Imaging, Brisbane, Qld, Australia
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14
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Katritsis DG. Choice of Ventricular Pacing Site: the End of Non-physiological, Apical Ventricular Pacing? Arrhythm Electrophysiol Rev 2018; 6:159-160. [PMID: 29326829 DOI: 10.15420/aer.2017.6.4:eo3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Witt CM, Lenz CJ, Shih HH, Ebrille E, Rosenbaum AN, van Zyl M, Aung H, Manocha KK, Deshmukh AJ, Hodge DO, Mulpuru SK, Cha YM, Espinosa RE, Asirvatham SJ, Mcleod CJ. Right ventricular pacemaker lead position is associated with differences in long-term outcomes and complications. J Cardiovasc Electrophysiol 2017; 28:924-930. [PMID: 28543771 DOI: 10.1111/jce.13256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/27/2017] [Accepted: 05/15/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Cardiac pacing from the right ventricular apex is associated with detrimental long-term effects and nonapical pacing locations may be associated with improved outcomes. There is little data regarding complications with nonapical lead positions. The aim of this study was to assess long-term outcomes and lead-related complications associated with differing ventricular lead tip position. METHODS AND RESULTS All adult patients who underwent dual-chamber pacemaker implantation from 2004 to 2014 were included if they had postprocedure chest radiographs amenable to lead position determination. Long-term outcomes and lead-related complication rates were recorded. These were compared at 5 years between: (1) apical and septal leads, (2) apical and nonseptal nonapical (NSNA), and (3) apical and septal with >40% ventricular pacing. We retrospectively evaluated 3,450 patients, which included 238 with a septal position and 733 with NSNA lead positions. Septal lead position was associated with a lower mortality compared to apical leads (24% vs. 31%, P = 0.02). In patients with greater than 40% pacing, septal leads were associated with significantly higher rates of incident atrial fibrillation compared to apical leads (49% vs. 34%, P = 0.04). NSNA positions were associated with a significantly higher rate of lead dislodgement (4% vs. 2%, P = 0.005) and need for revision (8% vs. 5%, P = 0.005). CONCLUSIONS Septal pacemaker lead position is associated with a lower mortality compared to apically placed leads, but a higher incidence of atrial fibrillation with higher percentage ventricular pacing. NSNA lead locations are associated with more complications and should be avoided.
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Affiliation(s)
| | | | | | | | | | | | - Htin Aung
- Department of Cardiovascular Diseases
| | | | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Cano Pérez Ó, Pombo Jiménez M, Coma Samartín R. Spanish Pacemaker Registry. Twelfth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2014). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:1138-1153. [PMID: 26553269 DOI: 10.1016/j.rec.2015.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/11/2015] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Óscar Cano Pérez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - Marta Pombo Jiménez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Estimulación Cardiaca, Hospital Costal de Sol, Marbella, Málaga, Spain
| | - Raúl Coma Samartín
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Cuidados Críticos Cardiológicos, Hospital 12 de Octubre, Madrid, Spain
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Registro Español de Marcapasos. XII Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2014). Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kumar V. Location! The unanswered question in right ventricular pacing. J Nucl Cardiol 2015; 22:912-5. [PMID: 25539604 DOI: 10.1007/s12350-014-0049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Vineet Kumar
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, 930 Faculty Office Towers, 510 20th Street South, Birmingham, AL, 35294-0006, USA.
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Kaye G. Pacing site in pacemaker dependency: is right ventricular septal lead position the answer? Expert Rev Cardiovasc Ther 2015; 12:1407-17. [PMID: 25418757 DOI: 10.1586/14779072.2014.979791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The right ventricular apex has been the traditional site for lead placement in patients with atrioventricular block. Pacing at the right ventricular apex may have long-term deleterious effects on left ventricular (LV) function, promoting heart failure and increasing mortality. Pacing at the right ventricular septum has been proposed to minimize deterioration in LV function. Although experimental data suggest that septal pacing protects LV function, clinical studies have provided conflicting results. A recent large study in patients with heart block did not show a protective effect with septal pacing. Other pacing approaches are becoming increasingly relevant; however, prediction of what method should be employed in which patient is not currently possible. Other factors such as baseline LV function and associated co-morbidities impact LV function, irrespective of pacing site. Continued monitoring of cardiac function post-implant is therefore critical to ongoing care. An algorithm for managing patients with atrioventricular block is proposed.
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Affiliation(s)
- Gerry Kaye
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba and University of Queensland, Brisbane 4102, Australia
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Herweg B, Singh R, Barold SS. Cardiac resynchronization therapy is appropriate for all patients requiring chronic right ventricular pacing: the pro perspective. Card Electrophysiol Clin 2015; 7:433-44. [PMID: 26304523 DOI: 10.1016/j.ccep.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Long-term right ventricular pacing has deleterious effects on the left ventricle (LV). The risk of pacemaker-induced cardiomyopathy (PICM) seems to be lower in patients with a normal LV ejection fraction (LVEF). Patients developing PICM respond favorably to a cardiac resynchronization therapy upgrade, suggesting that the dysfunction is partially reversible. Biventricular pacing has emerged as a treatment and/or prevention of PICM. Cumulative pacing greater than 40% of the time is considered the most important risk factor for PICM. No organizational guidelines exist for preventive biventricular pacing. The decision to pursue biventricular pacing should be individualized.
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Affiliation(s)
- Bengt Herweg
- Electrophysiology and Arrhythmia Services, Department of Cardiovascular Disease, Tampa General Hospital, University of South Florida Morsani College of Medicine, South Tampa Campus (5th Floor), Two Tampa General Circle, Tampa, FL 33606, USA.
| | - Robin Singh
- Department of Cardiovascular Disease, Tampa General Hospital, University of South Florida Morsani College of Medicine, South Tampa Campus (5th Floor), Two Tampa General Circle, Tampa, FL 33606, USA
| | - S Serge Barold
- Clinical Cardiac Electrophysiology, Department of Cardiovascular Disease, University of Rochester Medical Center, 2613 W Henrietta Road, Rochester, NY 14623, USA
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HUSSAIN MOHAMMADAKHTAR, FURUYA-KANAMORI LUIS, KAYE GERALD, CLARK JUSTIN, DOI SUHAILA. The Effect of Right Ventricular Apical and Nonapical Pacing on the Short- and Long-Term Changes in Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1121-36. [DOI: 10.1111/pace.12681] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 01/26/2023]
Affiliation(s)
- MOHAMMAD AKHTAR HUSSAIN
- From the Division of Epidemiology and Biostatistics; School of Public Health, The University of Queensland; Brisbane Australia
| | - LUIS FURUYA-KANAMORI
- Research School of Population Health; The Australian National University; Canberra Australia
| | - GERALD KAYE
- Department of Cardiology; Princess Alexandra Hospital; Brisbane Australia
- University of Queensland Medical School; Brisbane Australia
| | - JUSTIN CLARK
- Cochrane Acute Respiratory Infections Group, Faculty of Health Sciences and Medicine, Bond University; Gold Coast Australia
| | - SUHAIL A.R. DOI
- Research School of Population Health; The Australian National University; Canberra Australia
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22
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Zou C, Song J, Li H, Huang X, Liu Y, Zhao C, Shi X, Yang X. Right ventricular outflow tract septal pacing is superior to right ventricular apical pacing. J Am Heart Assoc 2015; 4:jah3942. [PMID: 25896891 PMCID: PMC4579934 DOI: 10.1161/jaha.115.001777] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The effects of right ventricular apical pacing (RVAP) and right ventricular outflow tract (RVOT) septal pacing on atrial and ventricular electrophysiology have not been thoroughly compared. Methods and Results To identify a more favorable pacing strategy with fewer adverse effects, 80 patients who had complete atrioventricular block with normal cardiac function and who were treated with either RVAP (n=42) or RVOT septal pacing (n=38) were recruited after an average of 2 years of follow‐up. The data from electrocardiography and echocardiography performed before pacemaker implantation and at the end of follow‐up were collected. The patients in the RVOT septal pacing and RVAP groups showed similar demographic and clinical characteristics before pacing treatments. After a mean follow‐up of 2 years, the final maximum P‐wave duration; P‐wave dispersion; Q‐, R‐, and S‐wave complex duration; left atrial volume index; left ventricular end‐systolic diameter; ratio of transmitral early diastolic filling velocity to mitral annular early diastolic velocity; and interventricular mechanical delay in the RVOT septal pacing group were significantly less than those in the RVAP group (P<0.05). The final left ventricular ejection fraction of the RVOT septal pacing group was significantly higher than that of the RVAP group (P<0.05). Conclusions Compared with RVAP, RVOT septal pacing has fewer adverse effects regarding atrial electrical activity and structure in patients with normal cardiac function.
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Affiliation(s)
- Cao Zou
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., J.S., H.L., X.Y.)
| | - Jianping Song
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., J.S., H.L., X.Y.)
| | - Hui Li
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., J.S., H.L., X.Y.)
| | - Xingmei Huang
- Department of Electrocardiography, First Affiliated Hospital of Soochow University, Suzhou, China (X.H., Y.L.)
| | - Yuping Liu
- Department of Electrocardiography, First Affiliated Hospital of Soochow University, Suzhou, China (X.H., Y.L.)
| | - Caiming Zhao
- Department of Echocardiography, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., X.S.)
| | - Xin Shi
- Department of Echocardiography, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., X.S.)
| | - Xiangjun Yang
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., J.S., H.L., X.Y.)
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Abstract
A number of trials have shown that irrespective of baseline QRS duration, left ventricular (LV) dysfunction and heart failure are more common in patients with right ventricular (RV) than in those with biventricular (BiV) pacing. By contrast, preliminary results of the BIOPACE trial (follow-up 5.6 years) yielded a disappointing comparison of RV vs. BiV pacing. Pacemaker-induced cardiomyopathy (PIC) may occur in patients with normal and abnormal LV ejection fractions (LVEF) and tends to occur if there is RV pacing more than 40 % of the time. Yet, some pacemaker-dependent patients do not develop LV dysfunction. PIC can be improved in about two thirds of patients by upgrading to a BiV system and the results are comparable to de novo BiV pacing in patients with a wide QRS complex. The findings of the BLOCK HF trial (2013) suggested that patients requiring pacing virtually 100 % of the time might benefit from BiV pacing irrespective of the LVEF (< 50 %), manifestations of heart failure, QRS duration, or functional class. These characteristics would generate many patients for BiV pacing. However, these recommendations should now be weighed against a more conservative approach based on the recently announced results of the BIOPACE trial. Organizational guidelines recommend BiV pacing for bradycardia irrespective of QRS duration for patients with LVEF < 35 %. At this time, BiV pacing for antibradycardia therapy (irrespective of QRS duration) has to be individualized in the setting of a normal or decreased LVEF (> 35 %) and according to the expected percentage of RV pacing. The benefit of BiV pacing should be considered against procedural complications, which are more frequent than with traditional RV pacing.
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Affiliation(s)
- S Serge Barold
- Florida Heart Rhythm Institute, 5 Tampa General Circle, 33606, Tampa, FL, USA,
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24
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Biventricular pacing for bradycardia: Are we there yet? J Electrocardiol 2015; 48:236-40. [DOI: 10.1016/j.jelectrocard.2014.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Indexed: 11/22/2022]
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Gillis AM. Optimal pacing for right ventricular and biventricular devices: minimizing, maximizing, and right ventricular/left ventricular site considerations. Circ Arrhythm Electrophysiol 2015; 7:968-77. [PMID: 25336367 DOI: 10.1161/circep.114.001360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The results from numerous clinical studies provide guidance for optimizing outcomes related to RV or biventricular pacing in the pacemaker and ICD populations. (1) Programming algorithms to minimize RV pacing is imperative in patients with dual-chamber pacemakers who have intrinsic AV conduction or intermittent AV conduction block. (2) Dual-chamber ICDs should be avoided in candidates without an indication for bradycardia pacing. (3) Alternate RV septal pacing sites may be considered at the time of pacemaker implantation. (4) Biventricular pacing may be beneficial in some patients with mild LV dysfunction. (5) LV lead placement at the site of latest LV activation is desirable. (6) Programming CRT systems to achieve biventricular/LV pacing >98.5% is important. (7) Protocols for AV and VV optimization in patients with CRT are not recommended after device implantation but may be considered for CRT nonresponders. (8) Novel algorithms to maximize the benefit of CRT are in evolution further.
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Affiliation(s)
- Anne M Gillis
- From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
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Guglin M, Barold SS. The role of biventricular pacing in the prevention and therapy of pacemaker-induced cardiomyopathy. Ann Noninvasive Electrocardiol 2015; 20:224-39. [PMID: 25564929 DOI: 10.1111/anec.12245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Right ventricular (RV) pacing produces well-known long-term deleterious effects not only on already compromised, but also on the normal left ventricle (LV). The activation pattern mimicks that of left bundle branch block, with delayed activation of the LV free wall, and results in electrical and mechanical dyssynchrony. Long-term mandatory (100%) RV pacing, increases LV dimensions and decreases the ejection fraction. Many of these negative effects of pacing can be overcome by biventricular pacing. In this review, we describe the characteristics of pacemaker-induced cardiomyopathy, its incidence, and the use of cardiac resynchronization therapy (CRT) for its therapy and prevention. The gaps in the current organizational guidelines for using CRT in the treatment of bradycardia are identified, and goals for future research are discussed.
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Affiliation(s)
| | - S Serge Barold
- University of Rochester School of Medicine and Dentistry, Rochester, NY
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Coma Samartín R, Cano Pérez Ó, Pombo Jiménez M. Registro Español de Marcapasos. XI Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2013). Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Coma Samartín R, Cano Pérez Ó, Pombo Jiménez M. Spanish Pacemaker Registry. Eleventh official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2013). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:1024-1038. [PMID: 25455755 DOI: 10.1016/j.rec.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/16/2014] [Indexed: 06/04/2023]
Abstract
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.
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Affiliation(s)
- Raúl Coma Samartín
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Cuidados Críticos Cardiológicos, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Óscar Cano Pérez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marta Pombo Jiménez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Estimulación Cardiaca, Hospital Costal de Sol, Marbella, Málaga, Spain
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Trypanosoma cruzi infection and host lipid metabolism. Mediators Inflamm 2014; 2014:902038. [PMID: 25276058 PMCID: PMC4168237 DOI: 10.1155/2014/902038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 08/05/2014] [Indexed: 01/14/2023] Open
Abstract
Trypanosoma cruzi is the causative agent of Chagas disease. Approximately 8 million people are thought to be affected worldwide. Several players in host lipid metabolism have been implicated in T. cruzi-host interactions in recent research, including macrophages, adipocytes, low density lipoprotein (LDL), low density lipoprotein receptor (LDLR), and high density lipoprotein (HDL). All of these factors are required to maintain host lipid homeostasis and are intricately connected via several metabolic pathways. We reviewed the interaction of T. cruzi with each of the relevant host components, in order to further understand the roles of host lipid metabolism in T. cruzi infection. This review sheds light on the potential impact of T. cruzi infection on the status of host lipid homeostasis.
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Coma Samartín R, Ruiz Mateas F, Fidalgo Andrés ML, Leal del Ojo González J, Pérez Álvarez L. Spanish pacemaker registry. 10th official report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2012). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:959-972. [PMID: 24774109 DOI: 10.1016/j.rec.2013.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/17/2013] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Raúl Coma Samartín
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain.
| | - Francisco Ruiz Mateas
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - María Luisa Fidalgo Andrés
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Complejo Hospitalario de León, León, Spain
| | - Juan Leal del Ojo González
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Luisa Pérez Álvarez
- Sección de Estimulación Cardiaca, Sociedad Española de Cardiología, Madrid, Spain; Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Juan Canalejo, A Coruña, Spain
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Coma Samartín R, Ruiz Mateas F, Fidalgo Andrés ML, Leal del Ojo González J, Perez Álvarez L. Registro Español de Marcapasos. X Informe Oficial de la Sección de Estimulación Cardiaca de la Sociedad Española de Cardiología (2012). Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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