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Triple-site pacing for cardiac resynchronization in atrial fibrillation – an opening onto different scenarios
Pacing multi-site para ressincronização cardíaca na fibrilhação auricular – uma janela com cenários diferentes
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Statistical significance p<0.05 (Pearson's r linear correlation coefficient). BEI: baroreflex effectiveness index; BNP: brain-type natriuretic peptide; LVESV: left ventricular end-systolic volume; VO<span class="elsevierStyleInf">2</span>: oxygen consumption.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "João Fernandes Serôdio, Mário Martins Oliveira, Sérgio Matoso Laranjo, Cristiano Tavares, Pedro Silva Cunha, Ana Abreu, Luísa Branco, Sandra Alves, Isabel Rocha, Rui Cruz Ferreira" "autores" => array:10 [ 0 => array:2 [ "nombre" => "João" "apellidos" => "Fernandes Serôdio" ] 1 => array:2 [ "nombre" => "Mário" "apellidos" => "Martins Oliveira" ] 2 => array:2 [ "nombre" => "Sérgio" "apellidos" => "Matoso Laranjo" ] 3 => array:2 [ "nombre" => "Cristiano" "apellidos" => "Tavares" ] 4 => array:2 [ "nombre" => "Pedro" "apellidos" => "Silva Cunha" ] 5 => array:2 [ "nombre" => "Ana" "apellidos" => "Abreu" ] 6 => array:2 [ "nombre" => "Luísa" "apellidos" => "Branco" ] 7 => array:2 [ "nombre" => "Sandra" "apellidos" => "Alves" ] 8 => array:2 [ "nombre" => "Isabel" "apellidos" => "Rocha" ] 9 => array:2 [ "nombre" => "Rui" "apellidos" => "Cruz Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255116300695" "doi" => "10.1016/j.repc.2015.11.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116300695?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916300678?idApp=UINPBA00004E" "url" => "/21742049/0000003500000006/v2_201704050129/S2174204916300678/v2_201704050129/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204916300666" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.12.021" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "819" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2016;35:331-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2718 "formatos" => array:3 [ "EPUB" => 199 "HTML" => 1980 "PDF" => 539 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation – Acute phase results from a prospective observational study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "331" "paginaFinal" => "338" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Pacing triple-site</span> para ressincronização cardíaca na fibrilhação auricular permanente – resultados da fase aguda de um estudo prospetivo observacional" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2173 "Ancho" => 1656 "Tamanyo" => 151516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Differences in cardiac output between Tri-V and Bi-V pacing (A), between Bi-V pacing and RVOT septal pacing, and between RVOT septal pacing and RV apical pacing (B). Bi-V: biventricular pacing; LV: left ventricular; RV: right ventricular; RVOT: right ventricular outflow tract; Tri-V: triple-site pacing.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Marques, Miguel Nobre Menezes, Gustavo Lima da Silva, Ana Bernardes, Andreia Magalhães, Nuno Cortez-Dias, Luís Carpinteiro, João de Sousa, Fausto J. Pinto" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Marques" ] 1 => array:2 [ "nombre" => "Miguel" "apellidos" => "Nobre Menezes" ] 2 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Lima da Silva" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Bernardes" ] 4 => array:2 [ "nombre" => "Andreia" "apellidos" => "Magalhães" ] 5 => array:2 [ "nombre" => "Nuno" "apellidos" => "Cortez-Dias" ] 6 => array:2 [ "nombre" => "Luís" "apellidos" => "Carpinteiro" ] 7 => array:2 [ "nombre" => "João" "apellidos" => "de Sousa" ] 8 => array:2 [ "nombre" => "Fausto J." "apellidos" => "Pinto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255116300683" "doi" => "10.1016/j.repc.2015.12.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116300683?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916300666?idApp=UINPBA00004E" "url" => "/21742049/0000003500000006/v2_201704050129/S2174204916300666/v2_201704050129/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Triple-site pacing for cardiac resynchronization in atrial fibrillation – an opening onto different scenarios" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "339" "paginaFinal" => "341" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Mário Oliveira" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Mário" "apellidos" => "Oliveira" "email" => array:1 [ 0 => "m.martinsoliveira@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Laboratório de <span class="elsevierStyleItalic">Pacing</span> e Eletrofisiologia, Serviço de Cardiologia, Hospital de Santa Marta, Carnaxide, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Pacing multi</span>-<span class="elsevierStyleItalic">site</span> para ressincronização cardíaca na fibrilhação auricular – uma janela com cenários diferentes" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiac resynchronization therapy (CRT), whether or not combined with an implantable cardioverter-defibrillator, is one of the most important innovations in the treatment of chronic heart failure (CHF). It is able to restore ventricular synchrony in patients with severe intraventricular conduction disturbances, particularly complete left bundle branch block or QRS interval >150 ms. These conduction disorders, found in a third of cases of severe CHF, lead to mechanical dyssynchrony and systolic dysfunction, and several large multicenter randomized trials have demonstrated that CRT improves functional class and quality of life and significantly reduces mortality and hospitalizations for CHF. This treatment modality is increasingly studied and used in clinical practice, with ever-growing numbers of specialists and reference centers, and, most importantly, with many thousands of patients treated successfully worldwide.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the consistently positive results of electromechanical resynchronization, including improvements in hemodynamic parameters and increased cardiac output, reverse remodeling and in a significant number of cases normalization of systolic function and left ventricular (LV) volumes, several important questions remain to be answered. One is how to improve the response rate to CRT (even when selected in accordance with the international guidelines, up to 30% of patients do not respond). Another is the question of the best pacing configuration (biventricular or multi-site). A third issue is how to improve CRT response in patients with CHF and atrial fibrillation (AF), who account for over 20% of individuals in the European cardiac resynchronization therapy survey, and for whom CRT is a class IIa recommendation, level of evidence B, since CRT is less beneficial in these patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Patients with AF undergoing CRT are generally older and have more comorbidities, lower response rates and higher overall mortality compared with those in sinus rhythm.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The article by Marques et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span> compares different LV pacing configurations in patients with permanent AF, QRS >120 ms (not necessarily with criteria for complete left bundle branch block) and ejection fraction (EF) <40% who had a CRT device implanted. In a single assessment up to one month after implantation, the authors determined the impact in the acute post-implantation phase of different pacing configurations on cardiac output (analyzed by invasive arterial pressure measurement), QRS duration and EF (calculated by echocardiography). They suggest that triple-site ventricular pacing (Tri-V) (right ventricular [RV] apex and right ventricular outflow tract [RVOT] plus left ventricle) produces better results in all three parameters than conventional biventricular (Bi-V) pacing (RV apex or RVOT plus left ventricle).</p><p id="par0020" class="elsevierStylePara elsevierViewall">This was not a study of clinical response rate or reverse remodeling during follow-up, but an analysis of the behavior of different variables in the acute phase (up to one month post implantation) that compared different configurations after 15 minutes of stable pacing. Its focus on patients with permanent AF makes the study more interesting, since other studies have shown less benefit in this patient group. Tri-V pacing has been studied by other authors, although all in relatively small samples and none exclusively of AF patients. In a 2012 study with 43 patients, Rogers et al. showed that Tri-V pacing was associated with better clinical and echocardiographic results than Bi-V pacing in 12-month follow-up.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> All the study population had EF <35% and QRS duration ≥150 ms but only 14% had AF. The 20 patients treated by Tri-V pacing with RV, high RV septum and LV leads had no better echocardiographic results than the Bi-V pacing group. In a comparison study of 21 patients in sinus rhythm (New York Heart Association class III or IV, EF <35% and QRS >120 ms), Yoshida et al., like Marques et al., showed that in the acute phase, Tri-V pacing (RV apex and RVOT plus LV) leads to significant QRS shortening and improvements in LV dP/dt, cardiac output, ventricular synchrony on echocardiography and EF, compared to Bi-V pacing.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The possibility of more options in multi-site pacing configurations may help improve resynchronization therapy by producing a pattern of ventricular activation that is closer to physiological depolarization, not only through more pacing sites, but also by enabling optimization of VV interval programming according to the type of mechanical dyssynchrony observed. In the study by Marques et al., it would have been interesting to have analyzed dyssynchrony by the different types of echocardiography available (septal flash or apical transverse motion, tissue synchronization imaging, tissue Doppler imaging, radial strain, and three-dimensional), in order to provide some objective correlation between the observed hemodynamic benefits and the degree of ventricular dyssynchrony. For example, when the LV lead was connected to the atrial channel, left pacing was always 25-40 ms earlier, while if the RVOT lead was connected to the atrial channel pacing was always earlier at this site. This possible limitation, which results from the impossibility of simultaneous triple-site pacing, could be tested in a detailed study of dyssynchrony.</p><p id="par0030" class="elsevierStylePara elsevierViewall">At a time of growing interest in multi-site and multi-point pacing for the treatment of CHF, there have still been few studies on dual-site RV pacing with LV pacing. Thus, the article by Marques et al. points to a viable alternative that is safe (with no increase in procedural or fluoroscopy times) and potentially beneficial in an important subgroup of CHF patients. Although the study population was small, it is also interesting to note that the results for the different parameters for Bi-V pacing with the lead in apical position or in the RVOT were similar. Other ways in which this study differs from the experience of other groups include the lower percentage of patients with ischemic cardiomyopathy (25%), the number who required atrioventricular node ablation (6/40, 15%) and, as pointed out by the authors, the equipment used to measure cardiac output (the FloTrac III™ Vigileo™ monitoring system, Edwards Lifesciences, Irvine, CA, USA), which has not been evaluated in this context.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The need for viable solutions to the problem of non-responders to CRT is reason to pursue triple-site pacing, which has the potential to improve patterns of electromechanical activation and thus ventricular performance. Future studies will be necessary to determine if this modality brings benefits to all patients (“one size fits all”), or whether selection of the best Tri-V configuration should be individualized according to the type of dyssynchrony identified. The TRIUMPH-CRT trial, designed to compare optimized Tri-V pacing (based on the left pre-ejection interval, measured during implantation) with standard Bi-V pacing in patients with severe systolic dysfunction and QRS >150 ms, without criteria for complete left bundle branch block, will provide valuable information on this important subject.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The relationship between electrocardiographic, hemodynamic and echocardiographic findings in the acute phase and sustained clinical benefit will need to be demonstrated in randomized trials with larger populations and long-term follow-up. In this context, Marques et al.’s study is a valid contribution to the search for viable options in the non-pharmacological treatment of CHF.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Oliveira M. <span class="elsevierStyleItalic">Pacing multi</span>-<span class="elsevierStyleItalic">site</span> para ressincronização cardíaca na fibrilhação auricular – uma janela com cenários diferentes. Rev Port Cardiol. 2016;35:339–341.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Brignole" 1 => "A. Auricchio" 2 => "G. Baron-Esquivias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/eht150" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "2281" "paginaFinal" => "2329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23801822" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac resynchronization therapy: history, present status, and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Jaffe" 1 => "D. 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Barra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2014.05.008" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2014" "volumen" => "33" "paginaInicial" => "717" "paginaFinal" => "725" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25457476" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation – acute phase results from a prospective observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Marques" 1 => "M. Nobre Menezes" 2 => "G. Lima da Silva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2015.12.006" "Revista" => array:7 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2016" "volumen" => "35" "numero" => "6" "paginaInicial" => "331" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27255170" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized double-blind crossover trial of triventricular versus biventricular pacing in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.P. Rogers" 1 => "P.D. Lambiase" 2 => "M.D. Lowe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfs004" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "495" "paginaFinal" => "505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22312038" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of triangle ventricular pacing on haemodynamics and dyssynchrony in patients with advanced heart failure: a comparison study with conventional bi-ventricular pacing therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Yoshida" 1 => "Y. Seo" 2 => "H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 5 | 10 |
| 2024 October | 28 | 25 | 53 |
| 2024 September | 37 | 21 | 58 |
| 2024 August | 36 | 25 | 61 |
| 2024 July | 26 | 26 | 52 |
| 2024 June | 25 | 16 | 41 |
| 2024 May | 49 | 27 | 76 |
| 2024 April | 25 | 20 | 45 |
| 2024 March | 24 | 24 | 48 |
| 2024 February | 21 | 41 | 62 |
| 2024 January | 24 | 36 | 60 |
| 2023 December | 19 | 24 | 43 |
| 2023 November | 23 | 14 | 37 |
| 2023 October | 15 | 15 | 30 |
| 2023 September | 25 | 17 | 42 |
| 2023 August | 18 | 17 | 35 |
| 2023 July | 14 | 12 | 26 |
| 2023 June | 27 | 6 | 33 |
| 2023 May | 29 | 18 | 47 |
| 2023 April | 14 | 6 | 20 |
| 2023 March | 17 | 17 | 34 |
| 2023 February | 15 | 20 | 35 |
| 2023 January | 14 | 18 | 32 |
| 2022 December | 21 | 24 | 45 |
| 2022 November | 36 | 27 | 63 |
| 2022 October | 22 | 21 | 43 |
| 2022 September | 13 | 16 | 29 |
| 2022 August | 28 | 39 | 67 |
| 2022 July | 25 | 35 | 60 |
| 2022 June | 15 | 13 | 28 |
| 2022 May | 16 | 32 | 48 |
| 2022 April | 20 | 17 | 37 |
| 2022 March | 14 | 26 | 40 |
| 2022 February | 21 | 27 | 48 |
| 2022 January | 17 | 27 | 44 |
| 2021 December | 13 | 24 | 37 |
| 2021 November | 37 | 31 | 68 |
| 2021 October | 19 | 38 | 57 |
| 2021 September | 19 | 30 | 49 |
| 2021 August | 30 | 31 | 61 |
| 2021 July | 12 | 23 | 35 |
| 2021 June | 16 | 19 | 35 |
| 2021 May | 26 | 41 | 67 |
| 2021 April | 28 | 17 | 45 |
| 2021 March | 54 | 32 | 86 |
| 2021 February | 48 | 18 | 66 |
| 2021 January | 18 | 9 | 27 |
| 2020 December | 33 | 6 | 39 |
| 2020 November | 25 | 14 | 39 |
| 2020 October | 17 | 13 | 30 |
| 2020 September | 59 | 14 | 73 |
| 2020 August | 17 | 7 | 24 |
| 2020 July | 48 | 17 | 65 |
| 2020 June | 20 | 7 | 27 |
| 2020 May | 41 | 10 | 51 |
| 2020 April | 30 | 8 | 38 |
| 2020 March | 42 | 13 | 55 |
| 2020 February | 53 | 33 | 86 |
| 2020 January | 31 | 4 | 35 |
| 2019 December | 23 | 2 | 25 |
| 2019 November | 28 | 11 | 39 |
| 2019 October | 35 | 2 | 37 |
| 2019 September | 30 | 9 | 39 |
| 2019 August | 26 | 6 | 32 |
| 2019 July | 45 | 12 | 57 |
| 2019 June | 25 | 8 | 33 |
| 2019 May | 39 | 5 | 44 |
| 2019 April | 28 | 15 | 43 |
| 2019 March | 15 | 10 | 25 |
| 2019 February | 36 | 8 | 44 |
| 2019 January | 16 | 7 | 23 |
| 2018 December | 24 | 13 | 37 |
| 2018 November | 92 | 8 | 100 |
| 2018 October | 184 | 13 | 197 |
| 2018 September | 73 | 15 | 88 |
| 2018 August | 23 | 5 | 28 |
| 2018 July | 19 | 2 | 21 |
| 2018 June | 24 | 5 | 29 |
| 2018 May | 48 | 4 | 52 |
| 2018 April | 35 | 9 | 44 |
| 2018 March | 68 | 5 | 73 |
| 2018 February | 63 | 4 | 67 |
| 2018 January | 48 | 11 | 59 |
| 2017 December | 84 | 13 | 97 |
| 2017 November | 50 | 17 | 67 |
| 2017 October | 33 | 11 | 44 |
| 2017 September | 32 | 16 | 48 |
| 2017 August | 31 | 14 | 45 |
| 2017 July | 26 | 13 | 39 |
| 2017 June | 42 | 9 | 51 |
| 2017 May | 31 | 6 | 37 |
| 2017 April | 11 | 2 | 13 |
| 2017 March | 23 | 50 | 73 |
| 2017 February | 25 | 3 | 28 |
| 2017 January | 36 | 0 | 36 |
| 2016 December | 32 | 8 | 40 |
| 2016 November | 23 | 3 | 26 |
| 2016 October | 20 | 13 | 33 |
| 2016 September | 30 | 5 | 35 |
| 2016 August | 14 | 2 | 16 |
| 2016 July | 48 | 13 | 61 |
| 2016 June | 7 | 21 | 28 |
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