Ma Ruisong, Liao Wang, Zhang Lili, Wang Sheng
Department of Cardiology, Hainan General Hospital, Haikou, China.
Department of Cardiology, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China.
Front Cardiovasc Med. 2025 Jul 31;12:1515954. doi: 10.3389/fcvm.2025.1515954. eCollection 2025.
Left ventricular (LV) guidewire pacing has been proven to be a safe and effective pacing mode for transcatheter aortic valve replacement (TAVR). However, the high pacing voltage threshold and impedance of LV guidewire pacing are potential risks for loss of capture and valve embolization. Moreover, decisions surrounding whether and when to perform percutaneous coronary intervention (PCI) are always heterogeneous in patients with severe aortic stenosis and coronary artery disease. As described in this case report, we attempted an optimized LV guidewire pacing mode with the lowest pacing voltage threshold and impedance, avoiding complications associated with additional vascular access and further reducing TAVR costs. In addition, we successfully performed simultaneous PCI in this patient with a vertically downward orifice of the right coronary artery (RCA), severe calcified stenosis in the RCA, horizocardia, and a dilated ascending aorta. This case report provides new evidence for LV guidewire pacing and the opportunity for PCI in TAVR procedures.
左心室（LV）导丝起搏已被证明是经导管主动脉瓣置换术（TAVR）的一种安全有效的起搏模式。然而，LV导丝起搏的高起搏电压阈值和阻抗是捕获失败和瓣膜栓塞的潜在风险。此外，对于严重主动脉瓣狭窄和冠状动脉疾病患者，围绕是否以及何时进行经皮冠状动脉介入治疗（PCI）的决策总是存在差异。如本病例报告所述，我们尝试了一种具有最低起搏电压阈值和阻抗的优化LV导丝起搏模式，避免了与额外血管通路相关的并发症，并进一步降低了TAVR成本。此外，我们成功地为该患有右冠状动脉（RCA）垂直向下开口、RCA严重钙化狭窄、心脏水平位和升主动脉扩张的患者同时进行了PCI。本病例报告为LV导丝起搏以及TAVR手术中进行PCI提供了新的证据。
