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Heart block and temporary pacing during rotational atherectomy

Michael D Mitar1, Shemer Ratner1, Shahar Lavi1

  • 1London Health Sciences Centre and Western University, London, Ontario, Canada.

The Canadian Journal of Cardiology
|March 10, 2015
PubMed

Insights

Temporary pacing is often used during rotational atherectomy (RA) due to conduction abnormalities. This study found heart block or pacing activation was more common with RA to the right coronary artery and left-dominant circumflex arteries, suggesting prophylactic pacing may be avoidable in other cases.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Rotational atherectomy (RA) during percutaneous coronary intervention can cause distal embolization, leading to conduction abnormalities and frequent use of temporary pacing.
  • The necessity of routine temporary pacing during RA remains unclear.

Purpose of the Study:

  • To investigate the incidence and predictors of intraprocedural heart block or pacemaker activation during rotational atherectomy.
  • To determine if prophylactic temporary pacing can be avoided in certain cases.

Main Methods:

  • Retrospective analysis of 134 consecutive patients undergoing RA between January 2011 and September 2013.
  • Evaluation of intraprocedural heart block or pacemaker activation.
  • Multivariate analysis to identify associated factors, including target vessel.

Main Results:

  • Temporary pacemaker insertion occurred in 50% of patients; 31% experienced heart block or pacemaker activation.
  • No significant differences in baseline or interventional characteristics were found between patients with and without heart block/pacing.
  • Target vessel was the only significant predictor: RA to the right coronary artery (53%) and left-dominant circumflex artery (62%) were associated with higher rates of heart block or pacing activation.

Conclusions:

  • Heart block or temporary pacing during RA is significantly associated with lesions in the right coronary artery and left-dominant circumflex artery.
  • Prophylactic pacemaker insertion may be safely avoided when performing RA on other coronary vessels.
Abstract

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