Author + information
- Sara Casquero Dominguez,
- Luis-S. Diaz de la Llera,
- Jose M. Cubero,
- Monica Fernandez Quero,
- Agustin Guisado Rasco,
- Francisco Jose Guerrero Marquez and
- Manuel Villa Gil-Ortega
Background: Rapid cardiac pacing is a technique used during transcatheter aortic valve implantation (TAVI) for decreasing cardiac output. Traditionally, the technique includes a venous approach to place a temporary pacemaker with an active-fixation in right ventricle (RV). An alternative to traditional technique can be rapid cardiac pacing using left ventricular (LV) guidewire. The purpose is to show the safety and efficacy of left ventricular pacing through guidewire used for valve implantation.
Methods: LV pacing was performed over the 0.035” guidewire (Safari2 pre-shaped guidewire, ®Boston) usually employed in TAVI. The external extreme of the wire was connected to the cathode of an external pacemaker using an alligator clamp and the anode was connected to a curved needle inserted into subcutaneous tissue at the right thigh of the patient, also using an alligator clamp. The adecuate insulation is provided by the TAVI catheter. In order to achieve an effective stimulation, the setting of the temporary pacemaker were an output set at máximum (20 V), sensitivity turned off and an asynchronous mode.
Results: From June 2016 to August 2016, 15 consecutive patients (STS risk score 5,66±3,16) underwent TAVI in our center employing this technique. Edward Sapien 3 valve was implanted in all patients, without predilation and direct implantationt in all cases. The stimulation rate was stablished before valve placement, usually 180–220 bpm, decreasing systolic blood pressure <50 mmHg. LV pacing was succesfully performed in all patients. There was no valve dislodgment during inflation. Posdilation was performed in two patients, again under rapid pacing with the LV guidewire. The mean fluoroscopy time was 18,2±4,2 min. No temporary RV pacing was required. No vascular complications or significative pericardial effusion were observed. In-hospital and at 30 days mortality was 0%.
Conclusions: In our experience, rapid cardiac LV pacing is effective and easily performed. This technique reduces costs, simplifies procedure and decreases possible complications associated to conventional pacing. Thus, it can be considered an alternative to traditional temporary RV pacing in the setting of TAVI.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: TAVR 1
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1114-166
- 2017 American College of Cardiology Foundation