Contemporary Review of the Methods for Rapid Ventricular Pacing During Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) is a widely accepted treatment strategy for patients with severe aortic stenosis across all risk profiles. Pacing stimulation of the right ventricle (RV) is the conventional method used during TAVR for rapid pacing during balloon dilatation and transcatheter heart valve deployment and for the management of acute bradyarrhythmias. However, RV pacing requires additional venous access and carries a risk of RV perforation and cardiac tamponade. An alternate strategy of utilizing the stiff guidewire in the left ventricle for direct left ventricle pacing during valve deployment is increasingly being adopted, as it may reduce procedure cost, duration, and radiation exposure and potentially mitigate the risks associated with RV pacing. The current review aims to discuss contemporary rapid pacing techniques for TAVR, including their relative safety, efficiency, and outcomes.