Section G, Device Implant-Explant, has been updated to include select permanent pacemakers. In fact, the data collection tool is designed to only collect resynchronization pacemakers, leadless single-chamber pacemakers, and HIS or LEF bundle pacemakers. Submitting this permanent pacemaker population is completely optional. If your facility chooses to enter permanent pacemakers, all CRTP, leadless pacemakers, and HIS bundle or LEF bundle pacemakers must be submitted. Please refer to the submission population document located under Resources, then select Documents for complete details. A CRTP procedure is the placement of a biventricular pacing system with no defibrillating capabilities. It sends signals to both ventricles with the purpose of resynchronizing the right and left ventricles, resulting in more effective contractility. It may or may not have an atrial lead. The leadless pacemaker is a self-contained generator and lead system implanted transvenously into the right ventricle. It is positioned at the apical septum. It requires no chest incision or subcutaneous pocket. This is an example of a leadless pacemaker. The pacing system is about the size of a vitamin capsule and has been FDA approved for Bradyarrhythmia management and AV synchronous pacing. The registry is including newer technologies such as HIS bundle and LEF bundle pacing. The picture on the left is an illustration of normal AV conduction with the HIS bundle and LEF bundle branches highlighted. The right illustration is a radiographic image of an implanted HIS bundle pacing lead and a LEF bundle branch pacing lead. The HIS bundle lead is placed near the annulus of the tricuspid valve and distal to the AV node. Capture enables rapid activation of the ventricles by engaging the HIS Purkinje system. On the ECG, select capture of the HIS bundle results in a QRS complex similar to normal conduction. This approach to pacing has been shown to minimize the potential for advanced structural remodeling and heart failure. However, there are higher pacing thresholds and lower R-wave amplitudes with a longer procedure time. LEF bundle pacing is an alternative method for delivering physiologic pacing to achieve electrical synchrony of the LEF ventricle by activating the LEF bundle branch. The pacing lead is placed into the LV septal subendocardium in the LEF bundle branch region. It is emerging as an option for patients with AV block and with or without LEF bundle branch block. Like HIS bundle pacing, LEF bundle branch pacing minimizes structural remodeling and heart failure. However, it has been shown to have lower pacing capture thresholds and larger R-waves resulting in better sensing of the ventricles. Additionally, there is a shorter procedure time. If device implanted sequence 7620 is coded yes, was there an attempt made to implant a HIS and or LEF bundle lead during the current procedure? Not attempted indicates no attempt was made to implant the HIS or LEF bundle lead. Successfully implanted indicates that a HIS or LEF bundle lead was implanted. Previously implanted indicates the patient already has a HIS or LEF bundle lead implanted. And implant unsuccessful indicates that there was an attempt made to implant the HIS or LEF bundle lead.

patient assessment

initial evaluation

frailty scale

chest pain symptoms

symptom onset

Device Implant-Explant

permanent pacemakers

data collection tool

resynchronization pacemakers

leadless pacemakers