Direct left ventricular guidewire pacing during balloon aortic valvuloplasty was associated with lower in-hospital mortality compared to temporary right ventricular pacing (2.0% vs. 9.8%, p=0.01).
Cohort (n=202)
Does direct rapid left ventricular guidewire pacing improve safety and procedural efficiency compared to temporary right ventricular pacemaker placement in patients undergoing balloon aortic valvuloplasty?
Direct rapid LV guidewire pacing during balloon aortic valvuloplasty is associated with shorter procedural times, lower radiation exposure, and fewer complications compared to traditional right ventricular temporary pacing.
Absolute Event Rate: 2% vs 9.8%
p-value: p=0.01
Background: Rapid ventricular pacing is mandatory for optimal balloon positioning during aortic valvuloplasty (BAV) in patients with severe aortic stenosis. We aimed to assess the safety and efficacy of direct left ventricular (LV) guidewire pacing in comparison with regular pacing induced by temporary pacemaker (PM) placement in the right ventricle. Methods: Direct rapid LV pacing was provided with a 0.035″ guidewire. Baseline clinical characteristics, echocardiographic and procedural data, as well as complication rates, were compared between the two groups. Results: A total of 202 patients undergoing BAV were enrolled (49.5% with direct LV guidewire pacing). The pacing success rate was 100%. In the direct LV guidewire pacing group, we found a lower radiation dose, shorter fluoroscopy and overall procedural time (0.16 vs. 0.28 Gy, p = 0.02; 5.4 vs. 10.3 min, p = 0.01; 17 vs. 25 min, p = 0.01; respectively). In addition, the complication rate was lower in that group (cardiac tamponades, vascular access site complications, blood transfusions rate, and in-hospital mortality: 0% vs. 3.9%; 4.0% vs. 15.7%; 2.0% vs. 12.7%; 2.0% vs. 9.8%, p = 0.01 for all, respectively). Conclusions: Direct rapid LV guidewire pacing is a simple, safe and effective option for BAV with a reduced complication rate compared to a temporary PM placed in the right ventricle.
Kleczyński et al. (Fri,) conducted a cohort in Severe aortic stenosis (n=202). Direct left ventricular (LV) guidewire pacing vs. Temporary pacemaker placement in the right ventricle was evaluated on In-hospital mortality (p=0.01). Direct left ventricular guidewire pacing during balloon aortic valvuloplasty was associated with lower in-hospital mortality compared to temporary right ventricular pacing (2.0% vs. 9.8%, p=0.01).
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