Cardiac implantable electronic devices in Bulgaria: results from the electronic registry BG-Pace for the period 2019-2021

The current study analyses the activity in cardiac pacing in Bulgaria in 2019, 2020 and 2021 based on data derived from a national registry of patients with cardiac electronic implantable devices (CIEDs). Materials and methods. Data from the national registry BG-Pace in the period 08.2019-06.2021 was retrospectively studied. Demographic data, procedure and device type, pacing mode, etiology, symptoms, preimplantation ECG, number of implantations and centre and operator volumes were analysed. Results. Six thousand nine hundred forty-nine devices were implanted by 47 operators in 28 centres for the study period. Median age was 75 (IQR 68-81, 21-103) years in males and 77 (IQR 71-82, 17-98) years in females, P< 0.05. The largest number of devices were implanted in the age group 70-79 years. The most commonly implanted CIEDs were antibradycardia devices with a total of 486.7/million implantations for the period 08.2019-08.2020 and 353.9/million for the period 08.2020-06.2021. Implanted cardioverter-deﬁbrillators demonstrated a growth from 14.1/million to 20.1/million in the period 08.2020 – 06.2021. The number of all implantations dropped signiﬁ cantly during the two epidemic waves of COVID-19. The mean number of implantations per centre and per operator for the whole period was 232.3±204 (2-705) and 148±139.1 (2-660), respectively. Dual chamber device implantations were more prevalent, representing 65.8% of implantations in AV block I and II degree, 63.5% in complete AV block, 59.8% in intraventricular conduction disturbances and 60.9% in sick sinus syndrome. Pacing modes with atrial sensing represented more than 55% of the implantations for all indications. Increasing age was associated with signiﬁ cantly more common use of VVI pacing mode (P < 0.001). Conclusion. The national registry BG-Pace includes systematic clinical, demographical and procedural data for CIED implantations in Bulgaria. Results demonstrate lower number of implantations compared to the average European volume. There was a signiﬁ cant drop in the implantation rate during the two waves of COVID-19.

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Lower pacemaker implantation rates for atrioventricular block during COVID-19

EP Europace ◽

10.1093/europace/euab116.385 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

D Zweiker ◽

T Puntus ◽

F Egger ◽

R Kriz ◽

J Koch ◽

...

Keyword(s):

Pacemaker Implantation ◽

Implantation Rate ◽

Time Frame ◽

Av Block ◽

Limited Data ◽

Conduction Disturbances ◽

Funding Sources ◽

Number Of Patients ◽

Implantation Rates ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The first wave of the COVID-19 crisis was associated with a reduction of patients presenting with acute cardiovascular disease. However, there is only limited data showing the trend of pacemaker implantations and their indications. Purpose To evaluate pacemaker implantations before, during and after the first COVID-19 wave, stratified by indication. Methods We analysed the weekly rates of pacemaker implantation at our centre during the first national lockdown for COVID-19 at the between 16 March 2020 and 29 April 2020 (weeks 12-17 / 2020), compared to the implantation rates 6 weeks before (weeks 6-11 / 2020), 6 weeks afterwards (weeks 18-23 / 2020), and the same time frame in 2017-2019. To reduce bias due to postponed planned procedures, we stratified pacemaker implantations into the following groups: total implantations (including box changes), new pacemaker implantations, implantation due to AV block, implantation due to supraventricular conduction disturbances, and other implantations. Results The total number of total weekly implantations was reduced from 10.7 (weeks 6-11 / 2020) to 4.2 (weeks 12-17 / 2020; -60.1%, p = 0.02). We found no significant reduction in the same time frame in 2017-2019 (6.5 vs. 6.1 per week, p = 0.29). We found a similar effect in "new" pacemaker implantations (8.5 vs. 3.2 per week, -62.7%, p = 0.02) and AV block (5.0 vs. 1.5 per week, -70%, p = 0.03). There was no reduction in pacemaker implantation due to sick sinus syndrome (2.5 vs. 0.8 per week, -66.7%, p = 0.12) and other indications (1.0 vs. 0.8 per week, -16.7%, p = 0.86). In the six following weeks (18-23 / 2020), the total numbers (6.0 per week) and indications other than AV block rose to baseline (p > 0.05), but patients with AV block were still less prevalent (1.7 per week, p = 0.04). Conclusion The reduction of total and new pacemaker implantations during the COVID-19 lockdown was mainly based on a reduced pacemaker implantation rate for AV block. This effect persisted even after the national lockdown. This analysis implies that a significant number of patients with AV block may have avoided medical contact during and after the lockdown and therefore have experienced increased mortality.

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77 Pacing mode influences exercise parameters in patients with implanted cardioverter defibrillators and impaired but not with preserved systolic function

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(06)80043-3 ◽

2006 ◽

Vol 5 (1) ◽

pp. 15-16

Author(s):

M WONISCH ◽

P LERCHER ◽

D SCHERR ◽

W KRAXNER ◽

R MAIER ◽

...

Keyword(s):

Systolic Function ◽

Pacing Mode ◽

Cardioverter Defibrillators

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A Historical Perspective of Cardiac Implantable Electronic Device Infection: How a Menace Can Drive Technological and Clinical Improvement

Hearts ◽

10.3390/hearts2020016 ◽

2021 ◽

Vol 2 (2) ◽

pp. 202-212

Author(s):

Giulia Massaro ◽

Igor Diemberger ◽

Matteo Ziacchi ◽

Andrea Angeletti ◽

Giovanni Statuto ◽

...

Keyword(s):

Electronic Device ◽

Positive Impact ◽

Delayed Diagnosis ◽

Implantation Rate ◽

Major Complication ◽

Lead Extraction ◽

Cardiac Implantable Electronic Devices ◽

Device Infection ◽

New Perspective ◽

Poor Outcomes

In recent decades there has been a relevant increase in the implantation rate of cardiac implantable electronic devices (CIEDs), albeit with relevant geographical inhomogeneities. Despite the positive impact on clinical outcomes, the possibility of major complications is not negligible, particularly with respect to CIED infections. CIED infections significantly affect morbidity and mortality, especially in instances of delayed diagnosis and appropriate treatment. In the present review, we will start to depict the factors underlying the development of CIED infection as well as the difficulties related to its diagnosis and treatment. We will explain the reasons underlying the need to focus on prophylaxis rather than treatment, in view of the poor outcomes despite improvements in lead extraction procedures. This will lead to the consideration of management of this complication in a hub-spoke manner, and to our analysis of the several technological and procedural improvements developed to minimize this complication. These include prolongation of CIED longevity, the development of leadless devices, and integrated prophylactic approaches. We will conclude with a discussion regarding new devices and strategies under development. This complete excursus will provide the reader with a new perspective on how a major complication can drive technological improvements.

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