Direct left ventricular wire pacing during transcatheter aortic valve implantation

Maciej Stąpór, Jarosław Trębacz, Łukasz Wiewiórka, Elżbieta Ostrowska-Kaim, Joanna Nawara-Skipirzepa, Robert Sobczyński, Janusz Konstanty-Kalandyk, Robert Musiał, Oksana Trębacz, Paweł Kleczyński, Krzysztof Żmudka, Bogusław Kapelak (+1 others)
2020 Kardiologia polska  
Rapid ventricular pacing is used during balloon aortic valvuloplasty, balloon-expandable transcatheter aortic valve implantation (TAVI) and for post-dilatation. Traditionally, the right ventricular (RV) lead pacing has been a gold standard. Direct left ventricular (LV) wire pacing has recently been considered safe and effective in TAVI interventions. The study aimed to analyze procedural outcomes of direct LV pacing compared to RV stimulation in unselected TAVI patients. Direct LV wire pacing
more » ... s provided via available pre-shaped guidewires and used only when no predictors of the atrioventricular block were present. The primary objective was the assessment of the efficacy of direct LV wire pacing. The secondary objectives were the appraisal of procedure duration and safety in comparison with the conventional method. A combined endpoint (MACE) consisting of death, stroke, venous puncture complications, and cardiac tamponade was defined. In 2017 and 2018, 143 patients underwent transfemoral TAVI. Of these, 114 (79.7%) had self-expandable valves implanted. Direct LV wire pacing was the dominant method of pacing (82 patients, 57.3%), and its efficacy was 97.6%. The procedural duration [IQR] was shorter in the direct LV wire pacing group (80 [70-90] vs. 85 [70-95] min, P = 0.02). MACE event was more frequent in the RV lead pacing group (11.5% vs. 4.9%), but no statistical significance was achieved (P = 0.13). Direct LV wire pacing during TAVI is simple, reproducible, and safe technique that provides a reliable, sustained stimulation with low rate of complications and potential reduction of procedural time.
doi:10.33963/kp.15440 pmid:32567288 fatcat:mafjl4zas5djxegnffwh5xak5e