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Resumen Introduccion y objetivos Se han desarrollado puntuaciones multiparametricas para una mejor estratificacion del riesgo en el sindrome de Brugada (SBr). Nuestro objetivo es validar 3 abordajes multiparametricos (las escalas Delise, Sieira y Shanghai BrS) en una cohorte de pacientes con sindrome de Brugada y estudio electrofisiologico (EEF). Metodos Pacientes diagnosticados de SBr y con un EEF previo entre 1998-2019 en 23 hospitales. Se utilizaron analisis mediante estadistico C y modelos de regresion de riesgos proporcionales de Cox. Resultados Se incluyo en total a 831 pacientes con una media de edad de 42,8 ± 13,1 anos; 623 (75%) eran varones; 386 (46,5%) tenian patron electrocardiografico (ECG) tipo 1; 677 (81,5%) estaban asintomaticos y 319 (38,4%) tenian un desfibrilador automatico implantable. Durante un seguimiento de 10,2 ± 4,7 anos, 47 (5,7%) sufrieron un evento cardiovascular. En la cohorte total, un ECG tipo 1 y sincope fueron predictivos de eventos arritmicos. Todas las puntuaciones de riesgo se asociaron significativamente con los eventos. Las capacidades discriminatorias de las 3 escalas fueron discretas (particularmente al aplicarlas a pacientes asintomaticos). La evaluacion de las puntuaciones de Delise y Sieira con diferente numero de extraestimulos (1 o 2 frente a 3) no mejoro sustancialmente el indice c de prediccion de eventos. Conclusiones En el SBr, los factores de riesgo clasicos como el ECG y el sincope previo predicen eventos arritmicos. El numero de extraestimulos necesarios para inducir arritmias ventriculares influye en las capacidades predictivas del EEF. Las escalas que combinan factores de riesgo clinico con EEF ayudan a identificar las poblaciones con mas riesgo, aunque sus capacidades predictivas siguen siendo discretas tanto en poblacion general con SBr como en pacientes asintomaticos.

Resumen Introduccion y objetivos El marcapasos transcateter Micra presenta una alta efectividad y una tasa de complicaciones mas baja que los marcapasos convencionales. Sin embargo, se desconoce su beneficio en la poblacion mas anciana (≥ 90 anos). El objetivo de este estudio es evaluar la efectividad y la seguridad de Micra en pacientes de edad ≥ 90 anos. Metodos Estudio observacional prospectivo con pacientes consecutivos mayores de 70 anos a los que se implanto un marcapasos Micra, divididos en 2 grupos de edad: ≥ 90 y Resultados El Micra se implanto en 129 pacientes, 41 tenian 90 o mas anos y 88, menos de 90. El implante fue exitoso en 40 pacientes (97,6%) de edad ≥ 90 anos y en 87 (98,9%) menores de 90 (p = 0,58). Fueron necesarias 2 o menos reposiciones en el 97,5 y el 91,9% de los pacientes respectivamente (p = 0,32). Los tiempos de procedimiento (26,1 ± 11,6 frente a 30,3 ± 14,2 min; p = 0,11) y de fluoroscopia (6,4 ± 4,7 frente a 7,2 ± 4,9 min; p = 0,41) fueron similares en ambos grupos. Hubo 3 complicaciones mayores (2,3%), todas en el grupo menor de 90 anos: 1 perforacion cardiaca, 1 hematoma femoral y 1 seudoaneurisma femoral. Un total de 13 pacientes de edad ≥ 90 anos (31,7%) y 16 de los menores de 90 (18,2%) murieron durante unos seguimientos medios de 230 ± 233 y 394 ± 285 dias respectivamente. No hubo muertes relacionadas con el dispositivo. No se observaron infeccion, dislocacion o migracion de Micra. El rendimiento electrico fue optimo en el seguimiento. Conclusiones El marcapasos sin cables Micra parece efectivo y seguro en pacientes mayores de 90 anos. Podria considerarse una alternativa razonable a la estimulacion transvenosa convencional en esta poblacion.

INTRODUCTION AND OBJECTIVES: Multiparametric scores have been designed for better risk stratification in Brugada syndrome (BrS). We aimed to validate 3 multiparametric approaches (the Delise score, Sieira score and the Shanghai BrS Score) in a cohort with Brugada syndrome and electrophysiological study (EPS). METHODS: We included patients diagnosed with BrS and previous EPS between 1998 and 2019 in 23 hospitals. C-statistic analysis and Cox proportional hazard regression models were used. RESULTS: A total of 831 patients were included (mean age, 42.8±13.1; 623 [75%] men; 386 [46.5%] had a type 1 electrocardiogram (ECG) pattern, 677 [81.5%] were asymptomatic, and 319 [38.4%] had an implantable cardioverter-defibrillator). During a follow-up of 10.2±4.7 years, 47 (5.7%) experienced a cardiovascular event. In the global cohort, a type 1 ECG and syncope were predictive of arrhythmic events. All risk scores were significantly associated with events. The discriminatory abilities of the 3 scores were modest (particularly when these scores were evaluated in asymptomatic patients). Evaluation of the Delise and Sieira scores with different numbers of extra stimuli (1 or 2 vs 3) did not substantially improve the event prediction c-index. CONCLUSIONS: In BrS, classic risk factors such as ECG pattern and previous syncope predict arrhythmic events. The predictive capabilities of the EPS are affected by the number of extra stimuli required to induce ventricular arrhythmias. Scores combining clinical risk factors with EPS help to identify the populations at highest risk, although their predictive abilities remain modest in the general BrS population and in asymptomatic patients.

Introduction and objectives: This report presents the findings of the 2018 Spanish Catheter Ablation Registry. Methods: Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers. Results: Data sent by 100 centers were analyzed, with a total number of 16,566 ablation procedures performed (the highest historically reported in this registry) for a mean of 165.5 ± 127.9 and a median of 119 procedures per center. The ablation targets most frequently treated were atrial fibrillation (n = 4234; 25.6%), atrioventricular nodal re-entrant tachycardia (n = 3525; 21.3%) and cavotricuspid isthmus (n = 3425; 20.7%). A new peak was observed in the ablation of atrial fibrillation, increasing the distance from the other substrates. The overall success rate was 91%. The rate of major complications was 2.2%, and the mortality rate was 0.04%. A total of 2.1% of the ablations were performed in pediatric patients. Conclusions: The Spanish Catheter Ablation Registry systematically and continuously enrolls the ablation procedures performed in Spain, showing a progressive increase in the number of ablations over the years, with a high success rate and low percentage of complications.

We describe through a clinical case some of the challenges we can face when remotely monitoring a patient with two devices. The case describes a patient with two leadless pacemaker in which data transmission by remote monitoring has been achieved.

Resumen Introduccion y objetivos Se describen los resultados del Registro Espanol de Ablacion con Cateter correspondientes al ano 2017. Metodos La recogida de datos se llevo a cabo de forma retrospectiva con la cumplimentacion de un formulario de recogida de datos de cada uno de los centros participantes. Resultados El numero total de procedimientos de ablacion fue de 15.284 realizados en 98 centros (mayor numero de centros y de procedimientos de ablacion comunicados historicamente en este registro) con una media de 156 ± 126 y una mediana de 136 procedimientos. El sustrato abordado con mas frecuencia ha sido por primera vez en el registro la fibrilacion auricular (n = 3.457; 22,6%), seguida del istmo cavotricuspideo (n = 3.449; 22,5%) y la taquicardia intranodular (n = 3.429; 22,4%). La tasa total de exito fue del 87%; la de complicaciones mayores, del 2,6% y la mortalidad, del 0,09%. Se ha producido un aumento de los procedimientos realizados sin apoyo de fluoroscopia hasta suponer un 6% del total de las ablaciones. Un 2,3% de las ablaciones se realizo en pacientes pediatricos. Conclusiones El Registro Espanol de Ablacion con Cateter recoge sistematica e ininterrumpidamente los procedimientos de ablacion realizados en Espana, y esto nos ha permitido observar un aumento progresivo del numero de ablaciones y de centros que las realizan manteniendo una tasa de exito elevada y unos porcentajes de complicaciones bajos.

Introduction and objectives: The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (>= 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients >= 90 years. Methods: We present a prospective observational study with consecutive patients aged > 70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: >= 90 and < 90 years. Results: The Micra system was implanted in 129 patients, of whom 41 were aged >= 90 years and 88 < 90 years. The device was successfully implanted in 40 (97.6%) patients >= 90 years and in 87 (98.9%) patients < 90 years (P = .58). An adequate position was achieved with need for = 90 years (31.7%) and 16 patients aged < 90 years (18.2%) died during a mean follow-up of 230 +/- 233 days and 394 +/- 285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. Conclusions: The Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population. (C) 2019 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Introduction and objectives: This report describes the findings of the 2017 Spanish Catheter Ablation Registry. Methods: Data collection was retrospective. A standardized questionnaire was completed by each of the participating centers. Results: A total of 15 284 ablation procedures were performed by 98 institutions (the highest number of ablations and institutions historically reported in this registry), with a mean of 156 ± 126 and a median of 136 procedures per center. For the first time, the most frequently treated ablation target was atrial fibrillation (n = 3457; 22.6%), followed by cavotricuspid isthmus (n = 3449; 22.5%) and atrioventricular nodal re-entrant tachycardia (n = 3429; 22.4%). The overall success rate was 87%. The rate of major complications was 2.6%, and the mortality rate was 0.09%. The percentage of procedures performed without fluoroscopic support increased to 6% of all ablations, and 2.3% of all ablations were performed in pediatric patients. Conclusions: The Spanish Ablation Catheter Registry systematically and uninterruptedly collects data on the ablation procedures performed in Spain, revealing that both the number of ablations and the number of centers performing them has progressively increased, while maintaining a high success rate and a low percentage of complications.

This article contains a review of some of the most significant advances in cardiac arrhythmias that have taken place in the last year, particularly those concerning the most common clinical conditions associated with the risk of arrhythmia, such as sudden cardiac death, atrial fibrillation and syncope, and genetically determined and hereditary heart disease, as well as advances concerning the principal nonpharmacologic treatments, such as catheter ablation, and the use of implantable defibrillators and cardiac resynchronization therapy.