Department of Cardiology, Thoraxcenter. Erasmus University Medical Center, Rotterdam, The Netherlands.
Catheter Cardiovasc Interv. 2022 Mar;99(4):1197-1205. doi: 10.1002/ccd.30026. Epub 2021 Nov 27.
To study the safety and feasibility of a restrictive temporary-RV-pacemaker use and to evaluate the need for temporary pacemaker insertion for failed left ventricular (LV) pacing ability (no ventricular capture) or occurrence of high-degree AV-blocks mandating continuous pacing.
Ventricular pacing remains an essential part of contemporary transcatheter aortic valve implantation (TAVI). A temporary-right-ventricle (RV)-pacemaker lead is the standard approach for transient pacing during TAVI but requires central venous access.
An observational registry including 672 patients who underwent TAVI between June 2018 and December 2020. Patients received pacing on the wire when necessary, unless there was a high-anticipated risk for conduction disturbances post-TAVI, based on the baseline-ECG. The follow-up period was 30 days.
A temporary-RV-pacemaker lead (RVP-cohort) was inserted in 45 patients, pacing on the wire (LVP-cohort) in 488 patients, and no pacing (NoP-cohort) in 139 patients. A bailout temporary pacemaker was implanted in 14 patients (10.1%) in the NoP-cohort and in 24 patients (4.9%) in the LVP-cohort. One patient in the LVP-cohort needed an RV-pacemaker for incomplete ventricular capture. Procedure time was significantly longer in the RVP-cohort (68 min [IQR 52-88.] vs. 55 min [IQR 44-72] in NoP-cohort and 55 min [IQR 43-71] in the LVP-cohort [p < 0.005]). Procedural high-degree AV-block occurred most often in the RVP-cohort (45% vs. 14% in the LVP and 16% in the NoP-cohort [p ≤ 0.001]). Need for new PPI occurred in 47% in the RVP-cohort, versus 20% in the NoP-cohort and 11% in the LVP-cohort (p ≤ 0.001).
A restricted RV-pacemaker strategy is safe and shortens procedure time. The majority of TAVI-procedures do not require a temporary-RV-pacemaker.
研究限制性临时右心室（RV）起搏器使用的安全性和可行性，并评估因左心室（LV）起搏能力失败（无心室夺获）或发生需要持续起搏的高度房室传导阻滞而需要插入临时起搏器的必要性。
心室起搏仍然是当代经导管主动脉瓣植入术（TAVI）的重要组成部分。临时 RV 起搏器导线是 TAVI 期间进行短暂起搏的标准方法，但需要中心静脉通路。
本观察性注册研究纳入了 2018 年 6 月至 2020 年 12 月期间接受 TAVI 的 672 例患者。当需要起搏时，患者会接受起搏治疗，除非根据基线心电图预计 TAVI 后存在传导障碍的高风险。随访期为 30 天。
在 45 例患者中插入了临时 RV 起搏器导线（RVP 组），在 488 例患者中进行了起搏（LVP 组），在 139 例患者中未进行起搏（NoP 组）。在 NoP 组中有 14 例（10.1%）和 LVP 组中有 24 例（4.9%）患者需要植入临时起搏器作为抢救治疗。在 LVP 组中，1 例患者因不完全心室夺获需要 RV 起搏器。RVP 组的手术时间明显长于 NoP 组（68 分钟[IQR 52-88]比 NoP 组的 55 分钟[IQR 44-72]和 LVP 组的 55 分钟[IQR 43-71]，p<0.005）。在 RVP 组中，手术过程中高度房室传导阻滞最常见（45%比 LVP 组的 14%和 NoP 组的 16%，p≤0.001）。在 RVP 组中，需要新的质子泵抑制剂（PPI）的比例为 47%，而 NoP 组为 20%，LVP 组为 11%（p≤0.001）。
限制性 RV 起搏器策略是安全的，并缩短了手术时间。大多数 TAVI 手术不需要临时 RV 起搏器。
