Why the study?
Rotational atherectomy PCI may cause transient bradycardia or heart block, prompting some operators to use prophylactic transvenous pacing wires, but the frequency of bail-out emergency pacing without upfront insertion was uncertain.
Is bail-out transvenous temporary pacing frequently required during rotational atherectomy PCI when a prophylactic pacing wire is not routinely used?
Is bail-out transvenous temporary pacing frequently required during rotational atherectomy PCI when a prophylactic pacing wire is not routinely used?
A standby temporary pacing strategy during rotational atherectomy PCI is safe and avoids unnecessary prophylactic pacing wire complications, as bail-out pacing is rarely required (0.3%).
Rare bail-out TPW need supports standby pacing in RA PCI; leaves open need for prospective trials before practice change.
Background Rotational atherectomy (RA) percutaneous coronary intervention (PCI) may cause transient bradycardia or heart block. Traditionally, some operators use prophylactic transvenous pacing wire (TPW) to avoid haemodynamic complications associated with bradycardia. We sought to establish the frequency of bail-out need for emergency TPW insertion in patients undergoing RA PCI that have received no upfront TPW insertion. Methods We performed a single-centre retrospective study of all patients undergoing RA PCI between October 2009 and October 2022. Patient characteristics, procedural variables and in-hospital complications were registered. Results A total of 331 patients who underwent RA procedure were analyzed. No patients underwent prophylactic TPW insertion. The mean age was 73.3±9.1 years, 71.6% (n=237) were male, while nearly half of patients were diabetic (N=47.7%, N=158). The right coronary artery was the most common target for RA PCI (40.8%), followed by left anterior descending (34.1%), left circumflex (14.8%) and left main stem artery (10.3%). Twenty (6%) of patients required intraprocedural atropine therapy. Emergency TPW insertion was needed in one patient (0.3%) only. Eight (2.4%) patients died, however only one was adjudicated as possibly related to RA-induced bradycardia. Five patients (1.5%) had ventricular fibrillation arrest while nine (2.7%) required cardiopulmonary resuscitation. Six (1.8%) procedures were complicated by coronary perforation, two (0.6%) were complicated by tamponade while 17 (5.1%) patients experienced vascular access complications. Conclusions Bail-out transvenous temporary pacing is very rarely required during RA PCI. A standby temporary pacing strategy is reasonable and may avoid unnecessary TPW complications compared to routine use.
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Schwarz et al. (2023) studied this question.
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