1LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; 2LMU Klinikum der Universität München Herzchirurgische Klinik und Poliklinik München, Deutschland; 3LMU Klinikum der Universität München Med. Klinik u. Poliklinik, Interventionelle Elektrophysiologie München, Deutschland
Background:
Transcatheter aortic valve replacement (TAVR) is an effective and safe therapy for severe aortic stenosis. Rapid or fast pacing is required for implantation, which can be performed via a pre-existing cardiac implantable electric device (CIED). However, safety data on CIED for pacing in TAVR are missing.
Objectives:
The aim of this study was to elucidate procedural safety and feasibility of internal pacing with CIED in TAVR.
Methods:
Patients undergoing TAVR with CIED were included into this analysis. Baseline characteristics, procedural details and complications according to Valve Academic Research Consortium (VARC) 3 criteria after TAVR were compared between both groups.
Results:
A total of 486 patients was included. Pacing was performed using the CIED in 150 patients and using transient pacemaker in 336 patients. No differences in technical success according to VARC-3 or procedure duration occurred between the groups. The usage of transient pacers for pacing was associated with a significantly higher bleeding rate (bleeding type ≥2 according to VARC-3-criteria; 2.0 vs. 13.1%,p<0.01). Furthermore, impairment of CIED appeared in 2.3% patients after TAVR only in the group where pacing was performed by transient pacer, leading to surgical revision of CIED in 1.3% of all patients when transient pacemakers were used.
| Total population (n=486) | Internal Pacing with CIED (n=150) | Pacing with transient pacemaker (n=336) | p-value | |
| Technical success according to VARC-3 | 474 (97.5%) | 145 (96.7%) | 329 (97.9%) | 0.96 |
| Cardiac structural complications according to VARC-3 | 4 (0.8%) | 0 | 4 (1.2%) | 0.18 |
| Major vascular complications according to VARC-3 | 18 (2.5%) | 8 (5.3%) | 10 (3.0%) | 0.20 |
| Bleeding Type ≥2 according to VARC-3 | 47 (9.7%) | 3 (2.0%) | 44 (13.1%) | <0.01 |
Conclusions:
Internal pacing using a CIED is safe and feasible without differences of procedural time and technical success and might reduce bleeding rates. Furthermore, pacing using a CIED circumvents the risk of lead dislocation. Our data give an urgent call for use of CIED for pacing during TAVR procedure in general.
Perspectives and impact on daily practice:
To use internal pacing with CIED in a safe and feasible way, a CIED check prior to TAVR procedure is needed to identify device and manufacturing special features usable for pacing. Temporary programming of CIED for pacing provides the simplest and most flexible operation mode and should be preferred. Alternatively, burst stimulation mode in ICD or threshold test with maximum output and maximum duration in pacemakers can be used.