{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T11:41:48Z","timestamp":1792237308746,"version":"4.4.0"},"reference-count":9,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Centralizing pacemaker implantations delays care for geriatric populations in remote regions, particularly in post\u2010Soviet healthcare systems like Latvia. We hypothesized that a regional hospital could safely establish a high\u2010volume pacing program to overcome geographical barriers, utilizing structured mentorship from a national tertiary center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 2\u2010year prospective observational study evaluated 173 consecutive patients (mean age 78.1 years) undergoing permanent pacemaker implantation at Daugavpils Regional Hospital. Procedures were performed by two regional interventional cardiologists transitioning to independent practice, supported by Latvian Cardiology Centre mentors. Endpoints included 30\u2010day major complications, procedural efficiency, surgical learning curve evaluation using Cumulative Sum (CUSUM) analysis, and patient\u2010reported quality of life (AQUAREL, SF\u201036).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 173 procedures (66.5% dual\u2010chamber, 33.5% single\u2010chamber), the overall complication rate was 5.7%. CUSUM analysis demonstrated a complication rate reduction from 8.7% during the initial acquisition phase to a 3.4% expertise plateau. Procedural efficiency stabilized with a mean fluoroscopy time of 3.9\u2009min. Specific complications included lead dislodgement (2.3%), pocket hematoma (1.7%), pneumothorax (1.1%), and wound infection (0.6%), managed successfully without mortality or device abandonment. At 6\u2010month follow\u2010up, patients reported significant quality of life improvements and high trust in the regional team.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Regional high\u2010volume cardiac pacing programs are safe and vital for equitable geriatric care. With structured mentorship, regional hospitals can overcome historical centralization, safely transitioning to independent high\u2010volume centers and achieving an expert\u2010level safety profile non\u2010inferior to tertiary standards.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70479","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:06:02Z","timestamp":1790687162000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Regionalization of High\u2010Volume Cardiac Pacing: A Prospective Cohort Study on Safety, Feasibility, and the Learning Curve in a Geriatric Population"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7141-4882","authenticated-orcid":false,"given":"Sergejs","family":"Pikta","sequence":"first","affiliation":[{"name":"Department of Cardiology and Internal Medicine Daugavpils Regional Hospital Daugavpils Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0281-6823","authenticated-orcid":false,"given":"Deniss","family":"Vasi\u013cjevs","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Internal Medicine Daugavpils Regional Hospital Daugavpils Latvia"},{"name":"Medical Faculty Riga Stradins University Riga Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaspars","family":"Kupics","sequence":"additional","affiliation":[{"name":"Latvian Cardiology Centre Pauls Stradins Clinical University Hospital Riga Latvia"},{"name":"Faculty of Medicine University of Latvia Riga Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5919-4995","authenticated-orcid":false,"given":"Oskars","family":"Kalejs","sequence":"additional","affiliation":[{"name":"Medical Faculty Riga Stradins University Riga Latvia"},{"name":"Latvian Cardiology Centre Pauls Stradins Clinical University Hospital Riga Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolajs","family":"Nesterovics","sequence":"additional","affiliation":[{"name":"Medical Faculty Riga Stradins University Riga Latvia"},{"name":"Latvian Cardiology Centre Pauls Stradins Clinical University Hospital Riga Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab364"},{"issue":"2","key":"e_1_2_11_3_1","first-page":"119","article-title":"The Pacemaker and Implantable Cardioverter\u2010Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing\u2014Annual Assessment 2016","volume":"19","author":"Proclemer A.","year":"2018","journal-title":"Italian Journal of Cardiology"},{"issue":"9","key":"e_1_2_11_4_1","first-page":"728","article-title":"Incidence and Predictors of Short\u2010 and Long\u2010Term Complications in Pacemaker Therapy: The FOLLOWPACE Study","volume":"98","author":"Udo E. O.","year":"2012","journal-title":"Heart"},{"issue":"11","key":"e_1_2_11_5_1","first-page":"1084","article-title":"Geographical Barriers to Access and Healthcare Outcomes: A Systematic Review of Cardiovascular Care in Rural Populations","volume":"123","author":"Rittenhouse B. E.","year":"2019","journal-title":"Health Policy"},{"issue":"5","key":"e_1_2_11_6_1","first-page":"512","article-title":"The AQUAREL, a Disease\u2010Specific Quality of Life Questionnaire for Pacemaker Patients","volume":"54","author":"Stofmeel P. A. M.","year":"2001","journal-title":"Journal of Clinical Epidemiology"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"issue":"3","key":"e_1_2_11_8_1","first-page":"233","article-title":"The Cumulative Sum (CUSUM) Control Chart for Monitoring Outcomes in Healthcare","volume":"17","author":"Biau D. J.","year":"2008","journal-title":"Quality & Safety in Health Care"},{"issue":"1","key":"e_1_2_11_9_1","first-page":"i1","article-title":"Statistics on the Use of Cardiac Electronic Devices and Electrophysiological Procedures in the European Society of Cardiology Countries: 2014 Report From the European Heart Rhythm Association (EHRA)","volume":"17","author":"Arribas F.","year":"2015","journal-title":"Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.959791"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.70479","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/clc.70479","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.70479","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T11:01:19Z","timestamp":1792234879000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.70479"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":9,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/clc.70479"],"URL":"https:\/\/doi.org\/10.1002\/clc.70479","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"assertion":[{"value":"2026-06-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70479"}}