Insights in a Restricted Temporary Pacemaker Strategy in a Lean Transcatheter Aortic Valve Implantation Program

Overview

Journal Catheter Cardiovasc Interv

Specialty Cardiology & Vascular Diseases

Date 2021 Nov 27

PMID 34837467

Citations 3

Authors

Thijmen W Hokken

Marjo de Ronde

Quinten Wolff

Thom Schermers

Joris F Ooms

Maarten P van Wiechen

Isabella Kardys

Joost Daemen

Peter P De Jaegere

Nicolas M Van Mieghem

Affiliations

Soon will be listed here.

Abstract

Objectives: To study the safety and feasibility of a restrictive temporary-RV-pacemaker use and to evaluate the need for temporary pacemaker insertion for failed left ventricular (LV) pacing ability (no ventricular capture) or occurrence of high-degree AV-blocks mandating continuous pacing.

Background: Ventricular pacing remains an essential part of contemporary transcatheter aortic valve implantation (TAVI). A temporary-right-ventricle (RV)-pacemaker lead is the standard approach for transient pacing during TAVI but requires central venous access.

Methods: An observational registry including 672 patients who underwent TAVI between June 2018 and December 2020. Patients received pacing on the wire when necessary, unless there was a high-anticipated risk for conduction disturbances post-TAVI, based on the baseline-ECG. The follow-up period was 30 days.

Results: A temporary-RV-pacemaker lead (RVP-cohort) was inserted in 45 patients, pacing on the wire (LVP-cohort) in 488 patients, and no pacing (NoP-cohort) in 139 patients. A bailout temporary pacemaker was implanted in 14 patients (10.1%) in the NoP-cohort and in 24 patients (4.9%) in the LVP-cohort. One patient in the LVP-cohort needed an RV-pacemaker for incomplete ventricular capture. Procedure time was significantly longer in the RVP-cohort (68 min [IQR 52-88.] vs. 55 min [IQR 44-72] in NoP-cohort and 55 min [IQR 43-71] in the LVP-cohort [p < 0.005]). Procedural high-degree AV-block occurred most often in the RVP-cohort (45% vs. 14% in the LVP and 16% in the NoP-cohort [p ≤ 0.001]). Need for new PPI occurred in 47% in the RVP-cohort, versus 20% in the NoP-cohort and 11% in the LVP-cohort (p ≤ 0.001).

Conclusion: A restricted RV-pacemaker strategy is safe and shortens procedure time. The majority of TAVI-procedures do not require a temporary-RV-pacemaker.

Citing Articles

Upper extremity versus lower extremity for secondary access during transcatheter aortic valve implantation: rationale and design of the randomised TAVI XS trial.

Rooijakkers M, Versteeg G, Hemelrijk K, Aarts H, Overduin D, van Ginkel D Neth Heart J. 2024; 32(7-8):270-275.

PMID: 38653922 PMC: 11239632. DOI: 10.1007/s12471-024-01869-5.

Best Practices in Left Ventricular Pacing for Transcatheter Aortic Valve Replacement.

Blusztein D, Raney A, Walsh J, Nazif T, Woods C, Daniels D Struct Heart. 2023; 7(6):100213.

PMID: 38046859 PMC: 10692352. DOI: 10.1016/j.shj.2023.100213.

Insights in a restricted temporary pacemaker strategy in a lean transcatheter aortic valve implantation program.

Hokken T, de Ronde M, Wolff Q, Schermers T, Ooms J, van Wiechen M Catheter Cardiovasc Interv. 2021; 99(4):1197-1205.

PMID: 34837467 PMC: 9539864. DOI: 10.1002/ccd.30026.

References

Mack M, Leon M, Thourani V, Makkar R, Kodali S, Russo M . Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1695-1705. DOI: 10.1056/NEJMoa1814052. View

Kappetein A, Head S, Genereux P, Piazza N, Van Mieghem N, Blackstone E . Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J. 2012; 33(19):2403-18. DOI: 10.1093/eurheartj/ehs255. View

Hokken T, de Ronde M, Wolff Q, Schermers T, Ooms J, van Wiechen M . Insights in a restricted temporary pacemaker strategy in a lean transcatheter aortic valve implantation program. Catheter Cardiovasc Interv. 2021; 99(4):1197-1205. PMC: 9539864. DOI: 10.1002/ccd.30026. View

Faurie B, Souteyrand G, Staat P, Godin M, Caussin C, Van Belle E . Left Ventricular Rapid Pacing Via the Valve Delivery Guidewire in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2019; 12(24):2449-2459. DOI: 10.1016/j.jcin.2019.09.029. View

Rodes-Cabau J, Ellenbogen K, Krahn A, Latib A, Mack M, Mittal S . Management of Conduction Disturbances Associated With Transcatheter Aortic Valve Replacement: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019; 74(8):1086-1106. DOI: 10.1016/j.jacc.2019.07.014. View

Reardon M, Van Mieghem N, Popma J, Kleiman N, Sondergaard L, Mumtaz M . Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017; 376(14):1321-1331. DOI: 10.1056/NEJMoa1700456. View

Faurie B, Abdellaoui M, Wautot F, Staat P, Champagnac D, Wintzer-Wehekind J . Rapid pacing using the left ventricular guidewire: Reviving an old technique to simplify BAV and TAVI procedures. Catheter Cardiovasc Interv. 2016; 88(6):988-993. DOI: 10.1002/ccd.26666. View

Li Y, Tsauo J, Liao Y, Zhao Z, Chen M . Comparison of third generation balloon-expandable Edwards Sapien 3 versus self-expandable Evolut R in transcatheter aortic valve implantation: a meta-analysis. Ann Palliat Med. 2020; 9(3):700-708. DOI: 10.21037/apm.2020.03.36. View

Mahajan S, Gupta R, Malik A, Mahajan P, Aedma S, Aronow W . Predictors of permanent pacemaker insertion after TAVR: A systematic review and updated meta-analysis. J Cardiovasc Electrophysiol. 2021; 32(5):1411-1420. DOI: 10.1111/jce.14986. View

10.

Popma J, Deeb G, Yakubov S, Mumtaz M, Gada H, OHair D . Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1706-1715. DOI: 10.1056/NEJMoa1816885. View

11.

Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, Campelo-Parada F, Puri R, Urena M . Impact of New-Onset Left Bundle Branch Block and Periprocedural Permanent Pacemaker Implantation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Circ Cardiovasc Interv. 2016; 9(5):e003635. DOI: 10.1161/CIRCINTERVENTIONS.115.003635. View

12.

Auffret V, Webb J, Eltchaninoff H, Munoz-Garcia A, Himbert D, Tamburino C . Clinical Impact of Baseline Right Bundle Branch Block in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2017; 10(15):1564-1574. DOI: 10.1016/j.jcin.2017.05.030. View

13.

Cahill T, Chen M, Hayashida K, Latib A, Modine T, Piazza N . Transcatheter aortic valve implantation: current status and future perspectives. Eur Heart J. 2018; 39(28):2625-2634. DOI: 10.1093/eurheartj/ehy244. View

14.

Siontis G, Juni P, Pilgrim T, Stortecky S, Bullesfeld L, Meier B . Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol. 2014; 64(2):129-40. DOI: 10.1016/j.jacc.2014.04.033. View

15.

Lilly S, Deshmukh A, Epstein A, Ricciardi M, Shreenivas S, Velagapudi P . 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020; 76(20):2391-2411. DOI: 10.1016/j.jacc.2020.08.050. View

16.

Rezq A, Basavarajaiah S, Latib A, Takagi K, Hasegawa T, Figini F . Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation: a single-center study. JACC Cardiovasc Interv. 2012; 5(12):1264-72. DOI: 10.1016/j.jcin.2012.08.012. View