Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Jan 13;6(2):ytac013.
doi: 10.1093/ehjcr/ytac013. eCollection 2022 Feb.

Trans-coronary pacing via Rota wire prevents bradycardia during rotational atherectomy: a case report

Hirofumi Kusumoto  1 , Kasumi Ishibuchi  1 , Katsuyuki Hasegawa  1 , Satoru Otsuji  1
Affiliations
Case Reports

Trans-coronary pacing via Rota wire prevents bradycardia during rotational atherectomy: a case report

Hirofumi Kusumoto et al. Eur Heart J Case Rep. .

Abstract

Back ground: Rotational atherectomy (RA) is used for plaque modification in patients with heavily calcified coronary lesions. Rotational atherectomy can induce significant bradycardia or atrioventricular block requiring for temporary pacemaker insertion. In this report, we present a case of trans-coronary pacing via a Rota wire to prevent bradycardia during RA in the proximal right coronary artery (RCA).

Case summary: A 72-year-old woman with a 1 month history of worsening effort angina was admitted to our hospital. Computed tomography coronary angiography disclosed significant coronary stenosis with severe calcification in proximal RCA. Coronary angiography revealed significant coronary stenosis with severe calcification in the proximal RCA. Subsequently, percutaneous coronary artery intervention was performed under the guidance of intravascular ultrasound (IVUS). The pull-back IVUS showed a circumferential calcified lesion in the proximal RCA that was treated using RA, which induced significant bradycardia requiring temporary pacemaker insertion. Immediately, trans-coronary pacing was provided via a Rota wire placed in the far distal RCA; this was used for back-up pacing during RA. Rotational atherectomy was completed by safely modifying the calcified lesion. After successful debulking of the calcified lesion, we dilated with a balloon, and a drug-eluting stent was implanted at the proximal RCA. Final IVUS and angiography showed good stent apposition and expansion. We did not observe any serious intraprocedural complications.

Discussion: Rotational atherectomy is used for plaque modification in patients with heavily calcified coronary lesions. Rotational atherectomy can induce significant bradycardia or atrioventricular block requiring for temporary pacemaker insertion via the transvenous route. This method could be an effective method to prevent bradycardia during RA.

Keywords: Calcified lesion; Case report; Percutaneous coronary artery intervention; Rotational atherectomy; Trans-coronary pacing.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Result of coronary angiography. (A) Initial angiography. Severely calcified lesion of the proximal right coronary artery (white arrow). (B) The tip of the Rota wire is advanced to the far distal end of the coronary artery (white arrow). (C) Rota burr was used in modifying heavily calcified stenosis. (D) Final PCI results.
Figure 2.
Figure 2.
How to attach the electrodes. (A) The cathode of an external pacemaker is attached to the distal external end of the guide wire using a crocodile clip. (B) The anode is attached to the needle which is inserted under the skin of the anaesthetized groin.
Figure 3
Figure 3
Results of electrocardiogram. (A) First atherectomy induced significant bradycardias and heart block. (B) Back-up pacing at 120 beats per minute with an output set at 8 V during rotational atherectomy.
None
See this image and copyright information in PMC

References

    1. Mitar MD, Ratner S, Lavi S.. Heart block and tempolary pacing during rotational atherectomy. Can J Cardiol 2015;31:335–340. - PubMed
    1. Heinroth KM, Stabenow I, Moldenhauer I, Unverzagt S, Buerke M, Werdan K. et al. Temporary trans-coronary pacing by coated guidewires: a safe and reliable method during percutaneous coronary intervention. Clin Res Cardiol 2006;95:206–211. - PubMed
    1. Heinroth KM, Unverzagt S, Mahnkopf D, Horenburg C, Melnyk H, Sedding D. et al. Transcoronary pacing in an animal model: second coated guidewire versus cutaneous patch as indifferent electrodes. Med Klin Intensivmed Notfmed 2021;doi: 10.1007/s00063-021-00806-3. - PubMed
    1. Lasa G, Larman M, Gaviria K, Sanmartin JC, Sadaba M, Rumoroso JR.. Coronary stent immobilization during angioplasty by transcoronary ventricular pacing via a guidewire. Rev Esp Cardiol 2009;62:288–292. - PubMed
    1. Mallek K, Dalton RT, Pareek N, Dworakowski R.. Rapid transcoronary pacing to facilitate ostial stent placement. JACC Cardiovasc Interv 2021;14: e111–e112. - PubMed

Publication types

LinkOut - more resources