Rapid Pacing Using the 0.035-in. Retrograde Left Ventricular Support Wire in 208 Cases of Transcatheter Aortic Valve Implantation and Balloon Aortic Valvuloplasty
Rapid Pacing Using the 0.035-in. Retrograde Left Ventricular Support Wire in 208 Cases of Transcatheter Aortic Valve Implantation and Balloon Aortic Valvuloplasty
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DOI：
10.1002/ccd.26720
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发表时间：
2017-03-01
影响因子：
2.3
通讯作者：
Hildick-Smith, David
中科院分区：
文献类型：
--
作者：
Hilling-Smith, Roland;Cockburn, James;Hildick-Smith, David
前言和方法：经导管主动脉瓣置入术(TAVI)和球囊主动脉瓣成形术(BAV)是目前公认的经皮手术。这些手术几乎总是需要一阵阵快速的心室起搏，以暂时减少心输出量，以方便手术，通常通过插入右心室的临时起搏钢丝完成。我们描述了132例TAVI和76例BAV的病例系列，通过左室起搏电极将一个电极简单地连接到患者的皮肤上，并将一个电极通过左心室(LV)导线连接到患者的皮肤上。结果：132例TAVI患者(Edwards Sapien、Medtronic CoreValve和Boston Science Lotus的混合体)和76例BAV均经LV导线起搏成功。无BAV患者需要放置临时起搏线(TPW)或永久性起搏器(PPM)。在TAVI患者中，6例(4.5%)因完全性心脏传导阻滞而在术中需要使用TPW，以便于拔除LV钢丝。1例(0.8%)因完全性心脏传导阻滞和血流动力学不稳定而紧急行PPM。28例患者(21.2%)在TAVI后需要进行PPM，其中9例在最初的24小时内。起搏器植入时间平均为3.7d。结论：经左心室钢丝快速起搏是经皮主动脉瓣介入和球囊主动脉瓣成形术的一种简单、安全、有效的方法。在绝大多数情况下，它消除了对临时起搏钢丝的需要，并伴随着风险。此外，大多数心脏起搏器在TAVI后需要延迟，在第一个24小时之后，在这个时间段之前，通常已经取出了TPW。(C)2016威利期刊公司。
Introduction and Method: Transcatheter aortic valve implantation (TAVI) and balloon aortic valvuloplasty (BAV) are now well established percutaneous procedures. These procedures almost always require bursts of rapid ventricular pacing to temporarily reduce cardiac output to facilitate the procedure, usually done via a temporary pacing wire inserted into the right ventricle. We describe a case series of 132 cases of TAVI and 76 BAV done using ventricular pacing via the left ventricular lead by simply connecting one electrode to the patient's skin and one electrode through the left ventricular (LV) wire. Results: All of the 132 TAVI cases (a mixture of Edwards Sapien, Medtronic CoreValve and Boston Scientific Lotus) and 76 BAV were successfully performed using pacing through the LV wire. No BAV patients required temporary pacing wire (TPW) or permanent pacemaker (PPM) insertion. Of the TAVI patients, 6 (4.5%) required TPW during the procedure due to complete heart block to facilitate removal of the LV wire. 1 patient (0.8%) required a PPM urgently due to complete heart block and haemodynamic instability. Twenty eight Patients (21.2%) required PPM following TAVI, 9 of which were within the first 24 hr. Average time to pacemaker implantation was 3.7 days. Conclusion: Rapid ventricular pacing via the LV wire is a simple, safe and effective strategy for percutaneous aortic valve intervention and balloon aortic valvuloplasty. It eliminates the need for a temporary pacing wire with its attendant risks in the vast majority of cases. Furthermore, most pacemakers following TAVI are required late, after the first 24 hr period, by which time the TPW has already usually been removed. (C) 2016 Wiley Periodicals, Inc.