Reducing cardiac tamponade caused by temporary pacemaker perforation in transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve replacement (TAVR) carries a risk of cardiac tamponade.
• Temporary right ventricular (RV) pacemaker perforation is a rare but serious complication.
• The type of temporary pacing lead may influence this risk.

Purpose of the Study:

• To investigate the incidence of temporary pacemaker-related cardiac tamponade during TAVR.
• To assess the relationship between the type of temporary RV pacing lead and cardiac tamponade events.

Main Methods:

• A single-center registry of transfemoral TAVRs (2014-2020) was analyzed.
• Patients received either a standard RV temporary pacing wire (RV-TPW) or a permanent, passive lead for temporary pacing (RV-TPPL).
• Cardiac tamponade was classified as pacemaker lead-related or other.

Main Results:

• Eighteen (2.2%) cardiac tamponade events occurred in 810 patients.
• All 12 pacemaker lead-related tamponades happened in the RV-TPW group (2.1%).
• No pacemaker lead-related tamponades occurred in the RV-TPPL group (0%), showing a statistically significant difference (p=0.022).

Conclusions:

• Soft-tip RV-TPPL is associated with a reduced risk of pacemaker-related cardiac tamponade in TAVR.
• Temporary RV-TPPL may significantly decrease cardiac tamponade incidence when perioperative pacing is needed during TAVR.