Rapid ventricular pacing in cerebral aneurysm clipping: institutional workflow, systematic review, and single-arm meta-analysis

BACKGROUND: This study examines the safety and efficacy of rapid ventricular pacing for cerebral aneurysm clipping, focusing on arrhythmia, mortality, aneurysm obliteration, neurological deficits, and myocardial damage assessed via postoperative troponin T levels, through an institutional series, systematic review, and meta-analysis. METHODS: Data were extracted from institutional database and published studies investigating the use of RVP in both ruptured and unruptured aneurysms. Outcomes analyzed included postoperative arrhythmia, mortality, complete obliteration of aneurysms, pacing cycles, mean arterial pressure (MAP) during pacing, pacing rates, and postoperative troponin T levels. Pooled event rates and proportions were calculated using a common effect model, and heterogeneity across studies was assessed using I² statistics. RESULTS: In 15 institutional cases, RVP-assisted aneurysm clipping achieved stable neurological outcomes, no cardiac complications, and 94% aneurysm obliteration. Combined with literature (141 patients), pooled arrhythmia and mortality rates were 1% and 0%, respectively. Aneurysm obliteration was 92%, new neurological deficits 4%, and troponin T levels 37.7 ng/L. Mean pacing rate, cycles, and MAP were 187.4 bpm, 6.5, and 41.1 mmHg. CONCLUSION: The findings suggest that rapid ventricular pacing in cerebral aneurysm clipping is associated with a low risk of cardiac arrhythmia and myocardial injury, while facilitating high rates of complete aneurysm obliteration. This technique appears safe, with minimal impact on postoperative mortality and neurological outcomes.