Spanish pacemaker registry. 23rd official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2025).

INTRODUCTION AND OBJECTIVES: This report presents data on cardiac pacing system implantation in Spain in 2025. METHODS: The registry is based on information provided by implanting centers to the Heart Rhythm Association of the Spanish Society of Cardiology following device implantation, through the national online registry platform, CardioDispositivos. Additional sources of information included: a) data provided by device manufacturers and distributors; b) the European pacemaker patient identification card; and c) local databases submitted by implanting centers. RESULTS: A total of 136 hospitals participated in the registry, 8 more than in 2024, and 26 130 devices were reported (1% fewer than in 2024). These accounted for 53% of all device implantations billed in Spain, with considerable geographical variation. The number of cardiac resynchronization therapy devices remained stable, whereas implantation of leadless pacemakers increased markedly (+ 62%). The most frequent indication was atrioventricular block, and the most commonly used pacing mode was DDD/R. Left bundle branch area pacing was reported in 27.3% of implants, and the axillary venous approach was used more often than the subclavian approach. Remote monitoring continued to increase overall, although its use declined for leadless pacemakers and cardiac resynchronization defibrillators. CONCLUSIONS: Participation in the Spanish pacemaker registry has stabilized, with data reported for 53% of implanted devices. The continued uptake of emerging therapies, such as conduction system pacing and leadless pacemaker implantation, is particularly noteworthy. Substantial geographical variation persists across all pacing modalities.