Key result
Real-time 3D TEE guidance for TAVI pacing linked to ~39% shorter needle-to-pace time versus fluoroscopy.
Why the study?
Fluoroscopic guidance is the traditional approach for transvenous temporary cardiac pacemaker implantation, but comparative data on the time, effectiveness, and safety of real-time 3D TEE guidance are needed.
Does real-time 3D TEE guidance reduce procedural time and complications compared to fluoroscopic guidance for transvenous temporary cardiac pacemaker implantation in patients undergoing TAVI?
Cohort (n=143)
Does real-time 3D TEE guidance reduce procedural time and complications compared to fluoroscopic guidance for transvenous temporary cardiac pacemaker implantation in patients undergoing TAVI?
Absolute Event Rate: 5.2% vs 8.5%
p-value: p=<0.001
Real-time 3D TEE guidance for temporary pacemaker implantation during TAVI is faster and associated with fewer complications compared to traditional fluoroscopic guidance.
May shorten temporary pacing time and reduce access complications in TAVI; hypothesis-generating, requiring randomized confirmation before practice change.
Background: Fluoroscopic guidance is the traditional method for the implantation of transvenous temporary cardiac pacemakers (TVTPs). This study aimed to compare the time, effectiveness, and safety of real-time three-dimensional transesophageal echocardiography (3D TEE) with those of fluoroscopy in guiding TVTP implantation. Methods: The records of patients who underwent transcatheter aortic valve implantation (TAVI) guided by real-time 3D TEE or fluoroscopy between July 1, 2016, and June 30, 2020, were retrospectively analyzed. TVTPs were implanted by anesthesiologists via the right internal jugular vein (IJV) in the real-time 3D TEE-guided group (3D TEE group), and by interventional cardiologists via the femoral vein in the fluoroscopy-guided group (fluoro group). Results: A total of 143 patients (3D TEE-group n=79, and fluoro group n=64) were included. No statistical differences were observed in the baseline characteristics of the two groups. TVTPs were successfully implanted in all of the patients. The needle-to-pace time was significantly shorter in 3D TEE group than in fluoro group (5.2±2.9 vs. 8.5±4.6 min, P<0.001). Further, the incidence of access complications was significantly lower in 3D TEE group than in fluoro group (3.8% vs. 12.5%, P<0.05). One patient in fluoro group who suffered cardiac perforation underwent drainage via pericardiocentesis. No patients in either group died because of TVTP placement. The total complication rates were significantly lower in 3D TEE group than in fluoro group (19.0% vs. 39.1%, P<0.05). No statistically significant differences existed between groups in terms of pacing threshold, the incidence of permanent pacemaker insertion after surgery, the length of postoperative intensive care unit (ICU) stay, or the duration of postoperative hospitalization. Conclusions: Real-time 3D TEE-guided can be used to effectively, quickly, and safely guide TVTP implantation. The procedure can be performed by properly trained anesthesiologists. Therefore, real-time 3D TEE is a suitable option for guiding perioperative TVTP implantation in patients undergoing cardiac surgery.
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Cao et al. (2020) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=143). Real-time three-dimensional transesophageal echocardiography (3D TEE) guidance vs. Fluoroscopic guidance was evaluated on Needle-to-pace time (minutes) (p=<0.001). Real-time 3D TEE guidance for temporary pacemaker implantation during TAVI significantly reduced needle-to-pace time (5.2 vs 8.5 min, P<0.001) compared to fluoroscopy.
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