Continuous electrocardiographic and hemodynamic monitoring are mandatory during IVL across all device platforms to detect myocardial capture. Operators should remain vigilant for R-on-T phenomena, which may pose a theoretical risk for malignant arrhythmias. The development of electrocardiogram-synchronized (gated) IVL delivery systems may represent a critical future step in eliminating the risk of R-on-T pulses and enhancing procedural safety.
Doğan et al. (2026) studied this question.