Transcutaneous Temporary Cardiac Pacing in Carotid Stenting: Noninvasive Prevention of Angioplasty-Induced Bradycardia and Hypotension

PURPOSE: To evaluate the feasibility, safety, and effectiveness of prophylactically placed noninvasive transcutaneous temporary pacemakers (NTP) to prevent angioplasty-induced bradycardia and hypotension during carotid angioplasty and stenting (CAS). METHODS: The preventive use of NTPs was evaluated in 31 CAS procedures performed at 3 institutions in 30 patients considered to be at high risk for developing angioplasty-induced bradycardia. Twenty-four cases in 23 patients (20 men; mean age 72 years, range 56-85) requiring intraprocedural pacing due to angioplasty-induced bradycardia were included in this study. Pacemakers were set to capture a heart rate <60 beats/min based on the basal heart rate. RESULTS: Noninvasive pacing was technically effective in producing electrical ventricular responses and was hemodynamically effective in most patients. All patients were easily and comfortably stimulated at amplitudes <50 mA (usually 30). There were no complications related to either pacemaker placement or performance. CONCLUSION: The prophylactic use of a noninvasive transcutaneous pacemaker for expected bradycardia during CAS appears to be safe and effective in preventing intraprocedural bradycardia and hypotension, with a decrease in additional pharmacological support during the procedures.