Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
Catheter Cardiovasc Interv. 2020 Apr 1;95(5):1042-1048. doi: 10.1002/ccd.28450. Epub 2019 Aug 20.
To develop a protocol for using a pre-existing, permanent pacemaker or defibrillator device for rapid ventricular pacing during transcatheter valve procedures and demonstrate feasibility.
Placement of a passive fixation, temporary pacemaker wire is considered routine during most transcatheter valve procedures to facilitate controlled or rapid ventricular pacing at the time of balloon expansion or valve deployment. Many patients presenting for such procedures have a pre-existing, permanent pacemaker or defibrillator device which could be used for the same function, obviating the need for temporary pacemaker wire placement.
We developed a strategy for rapid pacing from the pre-existing device using a programmer during transcatheter valve procedures in consecutive patients over a 3-month period. Complications and clinical outcomes were recorded.
There were 135 transcatheter valve procedures performed during the study. Of these, 28 (20.7%) had pre-existing devices (17 transcatheter aortic valve replacement, 3 aortic valve-in-valve, 2 mitral valve-in-valve, and 6 balloon aortic valvuloplasty). All patients underwent rapid ventricular pacing using a commercially available device programmer. There were no adverse events related to device pacing and no patients required placement of a temporary pacemaker wire during the procedure. At 30-days follow-up, there were no deaths, one major vascular complication related to arterial access, and one patient with renal failure requiring dialysis.
Pacing from a commercially available device programmer is safe, feasible, and may reduce both procedural cost and complications such as cardiac tamponade by avoiding placement of a temporary pacemaker lead during transcatheter valve procedures.
制定一个使用现有永久性起搏器或除颤器在经导管瓣膜手术中进行快速心室起搏的方案，并验证其可行性。
在大多数经导管瓣膜手术中，通常会放置被动固定的临时起搏器导丝，以便在球囊扩张或瓣膜植入时进行可控或快速心室起搏。许多接受此类手术的患者都有一个现有的永久性起搏器或除颤器，可以用于相同的功能，避免了临时起搏器导丝的放置。
我们在 3 个月的时间内，对连续的患者在经导管瓣膜手术中使用程控仪从现有的设备中进行快速起搏，制定了一项策略。记录并发症和临床结局。
研究期间共进行了 135 例经导管瓣膜手术。其中 28 例（20.7%）有现有的设备（17 例经导管主动脉瓣置换术、3 例主动脉瓣瓣中瓣、2 例二尖瓣瓣中瓣和 6 例球囊主动脉瓣成形术）。所有患者均使用市售的设备程控仪进行快速心室起搏。没有与设备起搏相关的不良事件，也没有患者在手术中需要放置临时起搏器导丝。在 30 天随访时，没有死亡，1 例与动脉入路相关的大血管并发症，1 例肾衰竭需要透析。
使用市售的设备程控仪起搏是安全可行的，可通过避免在经导管瓣膜手术中放置临时起搏器导丝来降低手术成本和心脏压塞等并发症的发生。
