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
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.
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.
