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Schwarz K, Mascherbauer J, Schmidt E, Zirkler M, Lamm G, Vock P, Kwok CS, Borovac JA, Mousavi RA, Hoppe UC, Leibundgut G, Will M. Emergency transvenous temporary pacing during rotational atherectomy. Front Cardiovasc Med 2023; 10:1322459. [PMID: 38162131 PMCID: PMC10755921 DOI: 10.3389/fcvm.2023.1322459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Rotational atherectomy (RA) during percutaneous coronary intervention may cause transient bradycardia or a higher-degree heart block. Traditionally, some operators use prophylactic transvenous pacing wire (TPW) to avoid haemodynamic complications associated with bradycardia. Objective We sought to establish the frequency of bail-out need for emergency TPW insertion in patients undergoing RA that have received no upfront TPW insertion. Methods We performed a single-centre retrospective study of all patients undergoing RA between October 2009 and October 2022. Patient characteristics, procedural variables, and in-hospital complications were registered. Results A total of 331 patients who underwent RA procedure were analysed. No patients underwent prophylactic TPW insertion. The mean age was 73.3 ± 9.1 years, 71.6% (n = 237) were male, while nearly half of the patients were diabetic [N = 158 (47.7%)]. The right coronary artery was the most common target for RA (40.8%), followed by the left anterior descending (34.1%), left circumflex (14.8%), and left main stem artery (10.3%). Altogether 20 (6%) patients required intraprocedural atropine therapy. Emergency TPW insertion was needed in one (0.3%) patient only. Eight (2.4%) patients died, although only one (0.3%) was adjudicated as being possibly related to RA-induced bradycardia. Five patients (1.5%) had ventricular fibrillation arrest, while nine (2.7%) required cardiopulmonary resuscitation. Six (1.8%) procedures were complicated by coronary perforation, two (0.6%) were complicated by tamponade, while 17 (5.1%) patients experienced vascular access complications. Conclusions Bail-out transvenous temporary pacing is very rarely required during RA. A standby temporary pacing strategy seems reasonable and may avoid unnecessary TPW complications compared with routine use.
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Affiliation(s)
- Konstantin Schwarz
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Julia Mascherbauer
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Elisabeth Schmidt
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Martina Zirkler
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Gudrun Lamm
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Paul Vock
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Chun Shing Kwok
- Department of Cardiology, University North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Josip Andelo Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split (KBC Split), Split, Croatia
| | - Roya Anahita Mousavi
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Uta C. Hoppe
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Leibundgut
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | - Maximilian Will
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St. Pölten, Austria
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Blusztein D, Raney A, Walsh J, Nazif T, Woods C, Daniels D. Best Practices in Left Ventricular Pacing for Transcatheter Aortic Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100213. [PMID: 38046859 PMCID: PMC10692352 DOI: 10.1016/j.shj.2023.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 12/05/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is continually evolving, with a recent emphasis on a "minimalist" approach toward reducing procedural invasiveness, duration, and recovery time. Whereas a better understanding of the relationship between TAVR and new conduction disturbances has led to improved periprocedural management, intraprocedural rapid-pacing techniques have not evolved beyond traditional right ventricular temporary pacing. An alternative strategy utilizing the left ventricular guidewire for rapid pacing has been developed with evidence supporting its safety, effectiveness, and potential reductions in procedure time and cost. This review will outline the current best practices in left ventricular pacing for TAVR, a practical technique that embraces the minimalist approach to TAVR and may be considered for routine use. It aims to explore the current evidence and combine this with expert opinion to offer a strategy for temporary pacing that encourages efficiencies for physicians and patients without compromising periprocedural safety.
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Affiliation(s)
- David Blusztein
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Aidan Raney
- Division of Cardiology, St. Joseph Hospital, Orange, California, USA
| | - Joe Walsh
- Division of Cardiology, St. Alphonsus Health System, Boise, Idaho, USA
| | - Tamim Nazif
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher Woods
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
| | - David Daniels
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
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