BACKGROUND: This case report highlights the novel role of His-bundle pacing (HBP) from right atrium, not just for preserving cardiac function, but also for avoiding interference with TriClip devices.
RESULTS: A 78-year-old female with severe tricuspid regurgitation received two TriClip devices. Postprocedure, frequent significant sinus pauses required a pacemaker. HBP was chosen to avoid lead complications. Under local anesthesia, a His pacing lead was inserted via the axillary vein using specialized catheter. Follow-ups over 2.5 years showed stable parameters with no complications.
CONCLUSIONS: HBP is effective for patients with TriClip devices, ensuring optimal cardiac function and lead stability.

BACKGROUND: Data on implants of cardiac pacing systems in Spain in 2023 are presented.
METHODS: The registry is based on the information provided by centers to the recording platform of the Heart Rhythm Association after device implantations, through Cardiodispositivos, the online platform of the National Registry. Other information sources include: a) data transfers from the manufacturing and marketing industry; b) the European pacemaker patient card; and c) local databases submitted by the implanting centers.
RESULTS: In 2023, 112 hospitals participated in the registry (30 more than in 2022). A total of 24 343 device implantations were reported (48.1% more than in 2022) compared with 45 120 reported by Eucomed (European Confederation of Medical Suppliers Associations). Of these, 1646 were cardiac resynchronization therapy pacemakers. The devices showing the largest increases were leadless pacemakers, with 963 devices implanted, representing an 18.1% increase over 2022. The most frequent indication was atrioventricular block followed, for the first time, by atrial tachyarrhythmia with slow ventricular response. The number of devices included in remote monitoring also increased (cardiac resynchronization therapy defibrillators, 71%; cardiac resynchronization therapy pacemakers, 63%; and conventional pacemakers, 28%), although more moderately.
CONCLUSIONS: In 2023, there was an increase in the number of institutions participating in the registry. The reporting of device implantations rose by 48.1%, and the implantation of leadless pacemakers grew by 18.1%. Remote monitoring also experienced modest growth compared with previous years. Full English text available from: www.revespcardiol.org/en.

BACKGROUND: Atrioventricular block (AVB) is common in the elderly and therefore considered to be a degenerative disease of the cardiac conduction system. However, there exist other etiologies contributing to AVB in young patients. This study aimed to determine the etiologies in patients aged before 60 years receiving their first pacemaker implantation for AVB in China.
RESULTS: Medical records and diagnostic tests of AVB patients were reviewed to identify the etiologies between 2010 and 2021 at Guangdong Provincial People\'s Hospital. Eight hundred and twenty-six patients (median age 47 years; 47.9% males) were included. The etiologies were identified in 336 (40.7%) cases, including complications to cardiac surgery (n = 190 [23.0%]), myocarditis (n = 57 [6.9%]), myocardial infarction (n = 25 [3.0%]), complications to catheter-based interventional procedures (n = 21 [2.5%]) and others (n = 43 [5.2%]). AVB caused by myocardial infarction was more common in men (5.8% vs. 0.5%, p < .001), while women received pacing treatment earlier (48 vs. 46 years, p = .019). Men were more likely to suffer from dilated cardiomyopathy (6.6% vs. 2.1%, p = .001) and atrial fibrillation/flutter (23.0% vs. 12.8%, p < .001). The number of first pacemaker implantation increased with age especially among patients with unclear etiologies.
CONCLUSIONS: The etiology of AVB was only determined in approximately 40% of patients receiving their first pacemaker implantation aged before 60 years. The predominance of AVB with unknown etiology and potential gender differences warrants further studies.

The landscape of cardiac pacemaker technology has undergone significant evolution over the last two decades, transitioning from simple single-chamber devices to sophisticated multi-chamber rate-responsive systems and cardioverter defibrillators. This progression has introduced a complex array of complications inherent to device implantation and operation, encompassing both mechanical and clinical challenges. These complications notably include lead dislodgment, device migration, venous thrombosis, and hemothorax, which not only affect patient outcomes but also impose substantial economic burdens. This review meticulously analyzes these complications, elucidating their mechanisms, clinical implications, and the economic consequences associated with their management. It also outlines current and emerging strategies aimed at mitigating these complications, emphasizing the need for continual updates in clinical practices and protocols. Through this discourse, the review seeks to equip clinicians with a comprehensive understanding of these complications, thereby enhancing the safety and efficacy of cardiac pacing interventions.

This review presents an in-depth examination of implantable antennas for various biomedical purposes. The development of implantable antennas, including their designs, materials, and operating principles, are introduced at the beginning of the discussion. An overview of the many kinds of implantable antennas utilized in implantable medical devices (IMDs) are presented in this study. The article then discusses the important factors to consider when developing implantable antennas for biomedical purposes, including implant placement, frequency range, and power needs. This investigation additionally examines the challenges and limitations encountered with implantable antennas, including the limited space available within the human body, the requirement for biocompatible materials, the impact of surrounding tissue on antenna performance, tissue attenuation, and signal interference. This review also emphasizes the most recent advances in implanted antenna technology, such as wireless power transmission, multiband operation, and miniaturization. Furthermore, it offers illustrations of several biomedical uses for implantable antennas, including pacemaker, capsule endoscopy, intracranial pressure monitoring, retinal prostheses, and bone implants. This paper concludes with a discussion of the future of implantable antennas and their possible use in bioelectronic medicine and novel medical implants. Overall, this survey offers a thorough analysis of implantable antennas in biomedical applications, emphasizing their importance in the development of implantable medical technology.

BACKGROUND: Conduction disturbances have uncertain implications for long-term left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR). We aimed to examine LVEF changes in patients up to two years post-TAVR.
METHODS: We examined patients who underwent TAVR between 2012 and 2020 and underwent echocardiography follow-up. Patients were categorized into four groups: 1) Those without a permanent pacemaker (PPM) or left bundle branch block (LBBB) pre- or post-TAVR; 2) Patients with pre- and post-TAVR LBBB; 3) Individuals with preexisting PPM; and 4) Patients requiring new PPM after TAVR. LVEF was assessed at the outset of TAVR, at 30 days, 1-year, and 2-years post-TAVR.
RESULTS: The study included 730 patients: 421 (57.6 %) without conduction abnormalities, 151 (20.7 %) with post-TAVR LBBB (48 pre-existing, 103 new-onset), 63 (8.6 %) with pre-existing PPM, and 95 (13.1 %) requiring new PPM. At discharge, patients without conduction abnormalities exhibited the highest LVEF (57.4 ± 11.5 %), whereas those with pre-existing PPM had the lowest (48.1 ± 15.5 %). Over two years, LVEF remained constant in patients without conduction issues and in those with pre-existing PPM. However, patients with new LBBB experienced a 6.3 % decrease in LVEF, and those requiring new PPM showed a 4.1 % reduction.
CONCLUSIONS: New conduction abnormalities, such as LBBB or the need for PPM, induce a decline in LVEF post-TAVR. It is imperative to focus on the long-term monitoring of left ventricular function in patients experiencing new conduction disturbances post-TAVR.

The 2018 guidelines of the European Society of Cardiology (ESC) provide improved algorithms for the diagnostics and treatment of syncope. New guidelines on ventricular tachycardia, on the prevention of sudden cardiac death and on cardiomyopathies and pacemakers have refined the recommendations. The detailed medical history and examination are crucial for differentiating between cardiac and noncardiac causes and determining the appropriate treatment. High-risk patients need urgent and comprehensive diagnostics. The basic diagnostics include medical history, physical examination and a 12-lead electrocardiography (ECG). Further tests, such as long-term ECG monitoring, implantable loop recorders and electrophysiological investigations are helpful in unclear cases. The treatment depends on the cause, with pacemaker implantation and implantable cardioverter defibrillators (ICD) being important for cardiac causes, while behavioral measures and medication management have priority for noncardiac syncope.
UNASSIGNED: Die 2018 veröffentlichten Leitlinien der European Society of Cardiology (ESC) bieten verbesserte Algorithmen für die Diagnostik und die Behandlung von Synkopen. Neue Leitlinien zu ventrikulären Tachykardien, zur Prävention des plötzlichen Herztodes sowie zu Kardiomyopathien und Schrittmachertherapie haben die Empfehlungen verfeinert. Die genaue Anamnese und Untersuchung sind entscheidend für die Differenzierung zwischen kardialen und nichtkardialen Ursachen sowie für die Festlegung der Therapie. Bei hohem Risiko ist eine rasche und umfassende Diagnostik notwendig. Die Basisdiagnostik umfasst Anamnese, körperliche Untersuchung und 12-Kanal-EKG(Elektrokardiographie). Weitere Tests wie Langzeit-EKG, implantierbare Ereignisrekorder und elektrophysiologische Untersuchungen sind bei unklaren Fällen hilfreich. Die Therapie richtet sich nach der Ursache, wobei Schrittmacherimplantationen und implantierbare Kardioverter-Defibrillatoren (ICD) bei kardialen Ursachen wichtig sind, während bei nichtkardialen Synkopen Verhaltensmaßnahmen und Medikamentenmanagement im Vordergrund stehen.

A large proportion of patients referred for transcatheter tricuspid valve intervention (TTVI) will have the presence of a cardiac implantable electronic device (CIED). In such patients, surgical correction of tricuspid regurgitation (TR) is associated with high rates of morbidity and mortality. Transvenous lead extraction (TLE) could potentially ameliorate CIED-induced TR; however, it carries inherent risks and frequently does not result in TR improvement. As multiple TTVI devices are in trial to gain regulatory approval, understanding which therapy is most appropriate among patients with a CIED is essential. This review centers on the nonsurgical treatment, including TLE and transcatheter tricuspid valve repair and replacement options, aimed at enhancing outcomes in patients with TR who also have concurrent CIEDs.

BACKGROUND: Modern cardiovascular implantable electronic devices (CIEDs) have mechanisms that prevent damage from external electric shocks, and malfunction following accidental electrocution is rare. However, the effects of lightning injuries in patients with CIEDs are uncertain.
METHODS: A 74-year-old man with a dual-chamber pacemaker due to complete heart block was struck by a lightning while farming. He had no serious injury at the time and sought medical evaluation 1 month later, when he presented with asymptomatic bradycardia. Device interrogation suggested major battery and lead damage, requiring extraction and subsequent placement of a new pacing system.
CONCLUSIONS: While a previous report depicted pacing threshold elevation without extensive device impairment, our patient presented with major damage to the whole pacing system. The factors contributing to these divergent outcomes are unclear. Differences in injury mechanism, pacemaker model, and the pattern of electric current dispersion within the device may each play a part in this discrepancy.

BACKGROUND: MICRA implantation is not commonly done as a day-case procedure. Elective leadless pacemakers are implanted routinely in our centre.
OBJECTIVE: To assess whether the day-case MICRA procedure is safe.
METHODS: We retrospectively collected data from all patients undergoing elective MICRA implantation at our centre between May 2014 and Nov 2022 (n = 81). Two patient groups were stratified: those planned to be discharged on the same day (SD, n = 52) and those planned to be observed overnight after the procedure (ON, n = 29). Patient demographics, size of the sheath used, type of MICRA device, and rate of complications were recorded. In patients with successful implants (n = 80), device function at discharge and first routine follow-up were evaluated.
RESULTS: There were 58% males in the SD group and 45% in the ON group. Median age was 49 years in the SD and 67 years in the ON. Among patients who were planned as a day case, 8 patients had to stay in the hospital but for < 48 h: 2 due to minor groin bleeding, 1 due to patient\'s request despite fit to discharge, 4 due to the procedure carried out later in the day, and 1 for observation due to procedural complexity. MICRA implantation was successful in 80 patients. The rate of the major complications was 2% in the SD group and 7% in the ON group (p = 0.223), and none of the co-morbidities assessed showed an association with any complications. Device parameters at the follow-up were available in 76 patients. The rate of patients with low and stable PCT at follow-up was also 98% in the SD group and 96% in the ON group.
CONCLUSIONS: Day case MICRA procedure can be performed safely in an appropriately selected patient population.