Introduction The most widespread venous sites of access for implantation intravenous implantable cardiac electronic device (CIED) are the cephalic and subclavian vein. Fluoroscopy‐guided axillary venous access is an alternative, but efficacy and safety have not been studied under equal conditions. The aim of the present study is to compare the efficacy and safety of fluoroscopy‐guided axillary vs cephalic vein access in CIED implant. Methods and Results Two hundred and forty patients were randomized to receive CIED implantation by the fluoroscopy‐guided axillary vein access vs cephalic vein access. The implantation success, the procedure times and the complications were recorded. A comparison of the results of operators was made. The success rate of the randomized venous access was superior in the axillary group than in cephalic (98.3% vs 76.7%, P < .001). Time to access (6.8 ± 3.1 minute vs 13.1 ± 5.8 minutes, P < .001) and implantation duration was significantly shorter in the axillary group than in the cephalic group (42.3 ± 11.6 minutes vs 50.5 ± 13.3 minutes, P < .001). There was no difference in the incidence of complication and inter‐operator success rate, complications rate and time to access. Conclusion The fluoroscopy‐guided axillary venous access is safe and has a better success rate and faster execution time compared with the cephalic vein access. When the results were compared among the study operators, neither in the axillary nor in the cephalic group there were differences in the success rate, the complication rate, and the time to access. Trial Registration: http://www.clinicaltrials.gov, NCT03860090

A 41-year-old man with a history of tachycardia refractory to multiple antiarrhythmic drugs was sent to our institution. His 12-lead electrocardiogram demonstrated incessant narrow QRS complex tachycardia with negative P waves in the inferior leads and long RP interval. Occasionally, the tachycardia terminated after a P wave and then was restarted after a sinusal beat. An EP study was performed during tachycardia. Intracardiac electrograms during tachycardia and response to pacing maneuvers are shown. What is the tachycardia mechanism?

Background: Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. Objective: We designed a prospective study to analyze the cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. Methods: An observational study including pacemaker implants in individual older than 70 years old in a single-center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long-term mortality, and functional status after implantation was undertaken. Results: About 60% of patients were older than 80 years old. The third-degree atrioventricular blockage (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel Index and functional status in this subgroup of patients, 3 years after pacing. Conclusions: Long-term mortality in individuals older than 80 years old with pacemaker implantation was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.

Objetivo: Describir el grado de satisfacción y el impacto sociolaboral y medioambiental de los pacientes de un programa de seguimiento remoto de marcapasos. Método: Estudio observacional prospectivo que incluyó 160 pacientes del programa de seguimiento remoto entre 2016 y 2017. Se pasó una encuesta de satisfacción a dichos pacientes y se cuantificó la disminución del CO 2 emitido al reducir el número de visitas. Resultados: Los pacientes acudían acompañados (86%) y en coche (66%) la mayoría de las veces, y mostraron un grado de satisfacción «bueno o excelente» en un 96%. Se estima un ahorro de emisión de CO 2 de casi un 10% por ciclo de seguimiento. Conclusiones: El seguimiento remoto de marcapasos implantado en nuestra unidad de arritmias reduce el impacto sociolaboral, económico y medioambiental.

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