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

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Pacing

Background:

• Transcatheter aortic valve implantation (TAVI) often necessitates ventricular pacing.
• The standard approach uses a temporary right-ventricle (RV) pacemaker, requiring central venous access.

Purpose of the Study:

• To assess the safety and feasibility of a restrictive temporary-RV-pacemaker strategy.
• To determine the necessity of temporary pacemaker insertion for failed left ventricular (LV) pacing or high-degree atrioventricular (AV) blocks.

Main Methods:

• An observational registry of 672 patients undergoing TAVI from June 2018 to December 2020.
• Patients received pacing on the wire unless high risk for conduction disturbances was predicted by baseline ECG.
• Follow-up was conducted for 30 days post-procedure.

Main Results:

• A restrictive RV-pacemaker strategy (pacing on the wire) was associated with shorter procedure times compared to routine RV-pacemaker use.
• Higher rates of procedural high-degree AV-block and need for permanent pacemaker (PPI) occurred in the RV-pacemaker cohort.
• Bailout temporary pacemakers were needed in 10.1% of the no-pacing group and 4.9% of the pacing-on-the-wire group.

Conclusions:

• A restrictive temporary-RV-pacemaker approach is safe and efficient for TAVI.
• The majority of TAVI procedures can be performed without the need for a temporary RV-pacemaker.