Impact of Rapid Ventricular Pacing During Transcatheter Implantation of Self-Expanding Aortic Valve Prostheses in Patients at Highest Risk

BACKGROUND: Patients with low-flow, low-gradient (LFLG) aortic stenosis (AS) have the highest risk among all AS patients. Rapid ventricular pacing (RVP) is frequently used during transcatheter aortic valve implantation (TAVI), but may negatively impact critical left ventricular function in these patients. We investigated the effects of RVP in patients with LFLG-AS undergoing implantation of a self-expandable valve prosthesis. METHODS: In this retrospective study, patients with LFLG-AS were classified according to the number of cumulative RVP episodes. RESULTS: Thirty-one patients with no episodes of RVP, 46 patients with 1 episode, and 40 patients with 2 or more episodes (2+) were identified. Society of Thoracic Surgeons (STS) scores in patients with 0, 1, or 2+ RVP episodes were 5.1% (interquartile range [IQR], 3.5%-8.9%), 6.0% (IQR, 3.8%-8.8%), and 4.8% (3.8%-8.1%), respectively. Peri-interventional adverse events tended to be highest in the group with 1 RVP. Residual aortic regurgitation was in 3.2%, 4.8%, and 2.6% (P=.87) in patients with 0, 1, and 2+ RVP episodes, respectively. Thirty-day mortality rates were 3.2%, 6.5%, and 7.5% (P=.74) and 1-year mortality rates were 22.6%, 30.4%, and 20.0% (P=.51) in patients with 0, 1, and 2+ RVP episodes, respectively. STS score, body mass index, prevalence of chronic lung disease, and more-than-mild residual aortic regurgitation emerged as independent predictors of 1-year mortality, whereas the number of RVP episodes had no impact on outcomes. CONCLUSIONS: One-year mortality is not influenced by RVP, but is influenced by the individual patient's risk. The final implantation results in patients with 2+ RVP episodes suggest that RVP during implantation of self-expandable TAVI prostheses should not be withheld in an attempt to achieve optimal results, even in LFLG-AS patients.