open access

Vol 78, No 9 (2020)
Original article
Published online: 2020-06-19
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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, Jacek Legutko
DOI: 10.33963/KP.15440
·
Pubmed: 32567288
·
Kardiol Pol 2020;78(9):882-888.

open access

Vol 78, No 9 (2020)
Original article
Published online: 2020-06-19

Abstract

Background: Rapid ventricular pacing is used during balloon aortic valvuloplasty, balloon‑expandable transcatheter aortic valve implantation (TAVI), and for postdilatation. Right ventricular (RV) lead pacing has been regarded as a gold standard. Direct left ventricular (LV) wire pacing has recently been considered safe and effective in TAVI interventions.

Aims: This study aimed to analyze procedural outcomes of direct LV pacing compared with RV stimulation in unselected patients undergoing TAVI.

Methods: Direct LV wire pacing was provided via available preshaped guidewires and used only when no predictors of atrioventricular block were present. The primary study objective was the assessment of the efficacy of direct LV wire pacing. The secondary objectives included the evaluation of procedure duration and safety in comparison with the conventional method. A combined endpoint (major adverse cardiovascular event) was defined as the occurrence of death, stroke, venous puncture–related complications, and cardiac tamponade.

Results: 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 reached 97.6%. The median (interquartile range) procedure time was shorter in the direct LV wire pacing group (80 [70–90] min vs 85 [70–95] min; P = 0.02). Major adverse cardiovascular events were more frequent in the RV lead pacing group (11.5% vs 4.9%), but no statistical significance was achieved (P = 0.13).

Conclusions: Direct LV wire pacing during TAVI is a simple, reproducible, and safe technique, which provides reliable, sustained stimulation with a low complication rate and potential reduction of procedural time.

Abstract

Background: Rapid ventricular pacing is used during balloon aortic valvuloplasty, balloon‑expandable transcatheter aortic valve implantation (TAVI), and for postdilatation. Right ventricular (RV) lead pacing has been regarded as a gold standard. Direct left ventricular (LV) wire pacing has recently been considered safe and effective in TAVI interventions.

Aims: This study aimed to analyze procedural outcomes of direct LV pacing compared with RV stimulation in unselected patients undergoing TAVI.

Methods: Direct LV wire pacing was provided via available preshaped guidewires and used only when no predictors of atrioventricular block were present. The primary study objective was the assessment of the efficacy of direct LV wire pacing. The secondary objectives included the evaluation of procedure duration and safety in comparison with the conventional method. A combined endpoint (major adverse cardiovascular event) was defined as the occurrence of death, stroke, venous puncture–related complications, and cardiac tamponade.

Results: 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 reached 97.6%. The median (interquartile range) procedure time was shorter in the direct LV wire pacing group (80 [70–90] min vs 85 [70–95] min; P = 0.02). Major adverse cardiovascular events were more frequent in the RV lead pacing group (11.5% vs 4.9%), but no statistical significance was achieved (P = 0.13).

Conclusions: Direct LV wire pacing during TAVI is a simple, reproducible, and safe technique, which provides reliable, sustained stimulation with a low complication rate and potential reduction of procedural time.

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About this article
Title

Direct left ventricular wire pacing during transcatheter aortic valve implantation

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 78, No 9 (2020)

Article type

Original article

Pages

882-888

Published online

2020-06-19

Page views

251

Article views/downloads

355

DOI

10.33963/KP.15440

Pubmed

32567288

Bibliographic record

Kardiol Pol 2020;78(9):882-888.

Authors

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
Jacek Legutko

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