Heart Block and Temporary Pacing During Rotational Atherectomy

Background: Rotational atherectomy (RA) performed during percutaneous coronary intervention is commonly associated with distal embolization of calcific particles resulting in conduction abnormalities. As a result, temporary pacing is often used during these procedures. It is unknown whether temporary pacing should be routinely used.

Methods: We performed an analysis of 134 consecutive patients who underwent RA at our institution between January 2011 and September 2013 for the presence of intraprocedural heart block or pacemaker activation.

Results: A temporary pacemaker was inserted in 50% of cases. Forty-two (31%) patients experienced either heart block (n = 16) or pacemaker activation (n = 26). There was no difference in baseline characteristics between those who experienced heart block or required temporary pacing, and those who did not. Interventional characteristics including burr size, maximum rotations per minute used, and maximum run duration were also similar among the groups. Only target RA vessel was associated with the presence of heart block or temporary pacing in multivariate analysis (P < 0.0001). Heart block or temporary pacing occurred in 28 (53%) of RA to the right coronary artery, 2 (5%) of the left anterior descending artery, 8 (62%) of the left-dominant circumflex artery, and 2 (18%) with RA to the circumflex artery with right-dominant circulation. Asystole occurred only in patients who underwent RA to the right coronary artery.

Conclusions: Heart block or temporary pacing was more commonly associated with right coronary artery and left-dominant circumflex lesions. Prophylactic pacemaker insertion might be avoided with RA to other vessels.