Optimizing the wire pacing technique in transcatheter aortic valve replacement procedures: the experience of using J-wire pacing at a single center

Background: During transcatheter aortic valve replacement (TAVR) procedures, traditional wire pacing demonstrates safety and efficacy profiles similar to, or even superior to, right ventricular pacing. However, it still has disadvantages such as high thresholds and impedance and unstable pacing in some patients. Methods: Our center pioneered the following J-wire pacing technique: inserting a J-wire through the auxiliary access 8F sheath (for balloon-expandable valves) or the main access 20F sheath (for self-expanding valves) into the descending aorta and aligning it at the same height as the left ventricular wire creates a loop circuit between the J-wire and the left ventricular wire after the balloon or prosthesis has been inserted into the annulus. This study included a total of 26 patients. The impedance and threshold of traditional wire pacing and J-wire pacing were measured, and the pacing method with the lower threshold was selected as the intraoperative pacing method. Results: All 26 patients were assigned to the J-wire pacing group, achieving a 100% surgical success rate. The proportion of patients with a pacing threshold ≤5 V was significantly higher compared to traditional wire pacing (76.92% vs. 0%), while the proportion with a threshold ≥10 V was significantly lower (0% vs. 38.46%). Conclusions: J-wire pacing offers improved safety and effectiveness compared to traditional wire pacing in TAVR procedures. We herein share this single-center experience, hoping to provide novel insights for the refinement of TAVR procedures.