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Case Reports
. 2023 Aug 8;10(8):341.
doi: 10.3390/jcdd10080341.

Intracoronary Pacing during "Chimney Technique" in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation?

Alessandro Cafaro  1 , Francesco Rizzo  2 , Dionigi Fischetti  1 , Luca Quarta  1 , Marco Mussardo  1 , Alessandro Mandurino-Mirizzi  1 , Antonio Tondo  1 , Marco Matteo Ciccone  2 , Fortunato Iacovelli  2   3 , Giuseppe Colonna  1
Affiliations
Case Reports

Intracoronary Pacing during "Chimney Technique" in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation?

Alessandro Cafaro et al. J Cardiovasc Dev Dis. .

Abstract

Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the "chimney technique", after unsuccessful RLE-TRVP.

Keywords: chimney technique; coronary artery occlusion; intracoronary pacing; transcatheter aortic valve implantation; valve-in-valve.

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Conflict of interest statement

Fortunato Iacovelli directly received speaker fees from General Electric Healthcare; the remaining authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Adaptive alligator clip connecting the guidewire to the pulse generator used as unipolar cathode and the skin needle used as indifferent electrode.
Figure 2
Figure 2
Left pressure wave flattening, via effective IC-TRVP.
Figure 3
Figure 3
“Chimney stent” (asterisk) positioning in LMCA and previously implanted LMCA edge aortic protrusion (arrow) immediately before valve implantation (A); “Chimney stent” protrusion into aorta (B) and postdilation (C); final left coronary angiography after Sapien 3 valve implantation (D).
Figure 4
Figure 4
LMCA stent implantation (A); subselective coronary angiography after stent implantation with Direct Flow leaflet (asterisk) near LMCA ostium after Evolut R release (B); stent protrusion into the aorta (C).
See this image and copyright information in PMC

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