Routine Left Ventricular Pacing for Patients Undergoing Transcatheter Aortic Valve Replacement

ABSTRACT

Background: Rapid ventricular pacing is often required during transcatheter aortic valve replacement (TAVR) procedures. Pacing via the retrograde left ventricular guidewire (LV-GW) is an alternative strategy to conventional pacing using a right ventricular temporary pacing wire (RV-TPW). We report our single center experience with this strategy.

Methods: Two-hundred twenty-six patients who underwent transfemoral TAVR using pacing via LV-GW were included in this retrospective observational study.

Results: LV-GW pacing was successful in 224 (99%) of the cases. In two (1%) patients, a RV-TPW was inserted after attempted LV-GW pacing because of stimulation failure (n = 1) or instability (n = 1). Procedural TAVR success was obtained in 94.7% of the cases. Procedural complication rate was low and included 2.7% vascular complications, 0.9% unsuccessful valve deployment and 3.1% in-hospital death. Pericardial effusion requiring intervention occurred in three (1.3%) cases and was related to LV perforation (0.9%) and annular rupture (0.4%). As expected, no case of RV perforation was observed.

Conclusions: Pacing using LV-GW is a valuable alternative to RV-TPW for TAVR procedures. This avoids the need for an RV-TPW placement and reduces the risk of cardiac tamponade from RV perforation.

KEYWORDS:

• Transcatheter aortic valve implantation
• structural heart interventions
• complications

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Acknowledgment

We would like to thank Mr David Gee for the IT support of the project.

Disclosure statement

Dr Scarsini received an educational and training grant from the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Professor Kharbanda and Professor Banning are partially founded by the Oxford National Institute for Health Research (NIHR).