Heart block and temporary pacing during rotational atherectomy

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.