Abstract
Background: Rapid ventricular pacing is mandatory for optimal balloon positioning during aortic valvuloplasty (BAV) in patients with severe aortic stenosis. We aimed to assess the safety and efficacy of direct left ventricular (LV) guidewire pacing in comparison with regular pacing induced by temporary pacemaker (PM) placement in the right ventricle. Methods: Direct rapid LV pacing was provided with a 0.035″ guidewire. Baseline clinical characteristics, echocardiographic and procedural data, as well as complication rates, were compared between the two groups. Results: A total of 202 patients undergoing BAV were enrolled (49.5% with direct LV guidewire pacing). The pacing success rate was 100%. In the direct LV guidewire pacing group, we found a lower radiation dose, shorter fluoroscopy and overall procedural time (0.16 vs. 0.28 Gy, p = 0.02; 5.4 vs. 10.3 min, p = 0.01; 17 vs. 25 min, p = 0.01; respectively). In addition, the complication rate was lower in that group (cardiac tamponades, vascular access site complications, blood transfusions rate, and in-hospital mortality: 0% vs. 3.9%; 4.0% vs. 15.7%; 2.0% vs. 12.7%; 2.0% vs. 9.8%, p = 0.01 for all, respectively). Conclusions: Direct rapid LV guidewire pacing is a simple, safe and effective option for BAV with a reduced complication rate compared to a temporary PM placed in the right ventricle.
Highlights
In a specific subset of patients with symptomatic aortic valve stenosis (AS), who are poor candidates for any definitive treatment due to severe comorbidities, balloon aortic valvuloplasty (BAV) can either serve as a standalone palliative procedure or as a bridge to final therapy [1]
In the LVP group radiation dose, fluoroscopy time and overall time of the procedure were reduced compared to the RVP group (0.16 vs. 0.28 Gy, p = 0.02; 5.4 vs. 10.3 min, p = 0.01; 17 vs. 25 min, p = 0.01; respectively), (Table 2)
Cardiac tamponade was caused by the temporary PM placed in the right ventricle (RV) in two cases confirmed by cardiac surgeons
Summary
In a specific subset of patients with symptomatic aortic valve stenosis (AS), who are poor candidates for any definitive treatment due to severe comorbidities, balloon aortic valvuloplasty (BAV) can either serve as a standalone palliative procedure or as a bridge to final therapy [1]. When performing a BAV, rapid ventricular pacing is required to achieve a cardiac standstill during the balloon inflation at the aortic site. It is provided, in most cases, with a temporary pacemaker (PM) inserted into the right ventricle (RV), which may increase the risk of major complications, including cardiac tamponade. We aimed to evaluate the pacing success rate and pacing-related complications of direct rapid LV guidewire pacing and pacing induced by a temporary PM placed in the RV in patients undergoing BAV. Conclusions: Direct rapid LV guidewire pacing is a simple, safe and effective option for BAV with a reduced complication rate compared to a temporary PM placed in the right ventricle
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