Congenital aortic stenosis: A novel technique for ventricular pacing during valvuloplasty

Abstract

The main objective of this study is to describe a new technique for rapid ventricular pacing to maintain balloon stability during balloon aortic valvuloplasty (BAV) without using transvenous temporary pacemaker electrode. The safety and efficacy of rapid right ventricular pacing to facilitate balloon stability during BAV has been previously reported. However, it necessitates an additional femoral venous access, an additional sheath, and a temporary pacemaker electrode. This was a prospective pilot study. Rapid ventricular pacing was performed through back-up guidewires inserted into the left ventricle for balloon advancement and by an adhesive patch placed on the back of the patient. The technique was performed during BAV procedure in all of 15 consecutive children diagnosed as congenital aortic stenosis. Pacing was performed at a rate decreasing systolic aortic pressure to the point of 40-50% of baseline. The technique was successful in all patients. Effective capture, stable pacing, and balloon stability were achieved in all children using very low outputs. No sustained arrhythmias or other procedure-related complications occurred. Mean aortic valve gradient decreased from 68.5 +/- 20.4 mm Hg to 20.4 +/- 10.2 mm Hg. Degree of aortic regurgitation progressed from grade 0 to 1 in three patients and remained unchanged in 12 patients. This study demonstrated that back-up guidewires can be used effectively and safely for pacing during BAV procedures. This technique omits probable complications related to a second vascular access and may shorten the procedure time and decreases costs by eliminating the use of an additional sheath and a temporary pacemaker electrode.