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Emergency transvenous temporary pacing during rotational atherectomy.

Konstantin Schwarz1, Julia Mascherbauer1, Elisabeth Schmidt1

  • 1Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria.

Frontiers in Cardiovascular Medicine
|January 1, 2024
PubMed
Summary

Routine prophylactic transvenous pacing wire (TPW) insertion is rarely needed during rotational atherectomy (RA). A standby temporary pacing strategy is reasonable, avoiding unnecessary TPW complications.

Keywords:
bradycardiacomplicationsconduction disordersheart blockpercutaneous coronary interventionrotational atherectomytransvenous temporary pacing

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Rotational atherectomy (RA) during percutaneous coronary intervention (PCI) can induce bradycardia or heart block.
  • Prophylactic transvenous pacing wire (TPW) insertion is traditionally used to prevent hemodynamic complications.

Purpose of the Study:

  • To determine the frequency of emergency TPW insertion in patients undergoing RA without prophylactic TPW.
  • To evaluate the safety and necessity of routine prophylactic TPW use.

Main Methods:

  • Single-center retrospective study of 331 patients undergoing RA from October 2009 to October 2022.
  • Analysis of patient characteristics, procedural variables, and in-hospital complications.
  • No patients received prophylactic TPW; 'bail-out' TPW use was tracked.

Main Results:

  • Only one patient (0.3%) required emergency TPW insertion.
  • Twenty patients (6%) received atropine; one death (0.3%) possibly related to RA-induced bradycardia.
  • Other complications included ventricular fibrillation (1.5%), CPR (2.7%), perforation (1.8%), tamponade (0.6%), and vascular access issues (5.1%).

Conclusions:

  • Emergency transvenous temporary pacing is rarely required during rotational atherectomy.
  • A standby temporary pacing strategy is a reasonable alternative to routine prophylactic TPW insertion.
  • This approach may reduce TPW-related complications.