Rapid pacing during aortic valve interventions: Review of pacing options and experience from Split

    Authors

    Keywords

    rapid pacing, aortic valve interventions, transcatheter aortic valve implantation

    DOI

    https://doi.org/10.15836/ccar2021.298

    Full Text

    Background : Rapid pacing during balloon aortic valvuloplasty (BAV) or transcatheter aortic valve replacement (TAVR) is an important step allowing for proper valve position and effective implantation while avoiding valve pop-up or ventricular complications. There are different regimes for rapid pacing during BAV/TAVR, some of which will be presented here ( 1 ). Materials and methods : Literature database PubMed has been reviewed yielding a total of 49 research articles related to rapid pacing during BAV/TAVR in the period of 2009 to 2021. Collected articles were assessed and reappraised to extrapolate different pacing options. Literature overview : Rapid pacing during BAV/TAVR can be achieved by insertion of a temporary transvenous pacemaker, reprogramming the existing permanent pacemaker in situ, or over-the-wire (OTW) pacing ( 1 ) ( Figure 1 ). The latter further includes different protocols. The most utilized OTW pacing protocol is based on the pacing circuit consisting of a positive pole attached to the wire in the left ventricle (isolated with the catheter), while a negative pole is attached to the femoral subcutaneous tissue over the needle. However, while the described protocol offers an attractive and simple set-up, it carries a risk of contact loss, inadequate pacing, or possibly insufficient post-implantation pacing ( 2 ). Therefore, we present our modification of the OTW pacing scheme which allows for a safer procedure and bail-out options if necessary ( Figure 1 ). Contrary to the conventional OTW scheme, our protocol includes the attachment of a negative pole to a wire in the inferior vein cava (5 French femoral sheath). This allows for stable contact, adequate length of the negative electrode, and quick bail-out insertion of a temporary transvenous pacemaker if necessary. Illustrative overview of rapid pacing methods during balloon aortic valvuloplasty or transcatheter aortic valve replacement. Conclusions : Rapid pacing during BAV/TAVR is an important procedural step, and different methods have been described to achieve this. Modification of the existing protocol may lead to additional benefits and a more convenient procedure.

    Cardiologia Croatica
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    Rapid pacing during aortic valve interventions: Review of pacing options and experience from Split

    Extended Abstract
    Issue9-10
    Published
    Pages298-299
    PDF via DOIhttps://doi.org/10.15836/ccar2021.298
    rapid pacing
    aortic valve interventions
    transcatheter aortic valve implantation

    Authors

    Frane RunjićORCIDUniversity Hospital Centre Split, Split, Croatia
    Andrija Matetić*ORCIDUniversity Hospital Centre Split, Split, Croatia
    Ivica KristićORCIDUniversity Hospital Centre Split, Split, Croatia
    Nikola CrnčevićORCIDUniversity Hospital Centre Split, Split, Croatia

    Full Text

    Background : Rapid pacing during balloon aortic valvuloplasty (BAV) or transcatheter aortic valve replacement (TAVR) is an important step allowing for proper valve position and effective implantation while avoiding valve pop-up or ventricular complications. There are different regimes for rapid pacing during BAV/TAVR, some of which will be presented here ( 1 ). Materials and methods : Literature database PubMed has been reviewed yielding a total of 49 research articles related to rapid pacing during BAV/TAVR in the period of 2009 to 2021. Collected articles were assessed and reappraised to extrapolate different pacing options. Literature overview : Rapid pacing during BAV/TAVR can be achieved by insertion of a temporary transvenous pacemaker, reprogramming the existing permanent pacemaker in situ, or over-the-wire (OTW) pacing ( 1 ) ( Figure 1 ). The latter further includes different protocols. The most utilized OTW pacing protocol is based on the pacing circuit consisting of a positive pole attached to the wire in the left ventricle (isolated with the catheter), while a negative pole is attached to the femoral subcutaneous tissue over the needle. However, while the described protocol offers an attractive and simple set-up, it carries a risk of contact loss, inadequate pacing, or possibly insufficient post-implantation pacing ( 2 ). Therefore, we present our modification of the OTW pacing scheme which allows for a safer procedure and bail-out options if necessary ( Figure 1 ). Contrary to the conventional OTW scheme, our protocol includes the attachment of a negative pole to a wire in the inferior vein cava (5 French femoral sheath). This allows for stable contact, adequate length of the negative electrode, and quick bail-out insertion of a temporary transvenous pacemaker if necessary. Illustrative overview of rapid pacing methods during balloon aortic valvuloplasty or transcatheter aortic valve replacement. Conclusions : Rapid pacing during BAV/TAVR is an important procedural step, and different methods have been described to achieve this. Modification of the existing protocol may lead to additional benefits and a more convenient procedure.