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. 2023 Dec 14:10:1322459.
doi: 10.3389/fcvm.2023.1322459. eCollection 2023.

Emergency transvenous temporary pacing during rotational atherectomy

Konstantin Schwarz  1 , Julia Mascherbauer  1 , Elisabeth Schmidt  1 , Martina Zirkler  1 , Gudrun Lamm  1 , Paul Vock  1 , Chun Shing Kwok  2 , Josip Andelo Borovac  3 , Roya Anahita Mousavi  1 , Uta C Hoppe  4 , Gregor Leibundgut  5 , Maximilian Will  1   6
Affiliations

Emergency transvenous temporary pacing during rotational atherectomy

Konstantin Schwarz et al. Front Cardiovasc Med. .

Abstract

Background: Rotational atherectomy (RA) during percutaneous coronary intervention may cause transient bradycardia or a higher-degree heart block. Traditionally, some operators use prophylactic transvenous pacing wire (TPW) to avoid haemodynamic complications associated with bradycardia.

Objective: We sought to establish the frequency of bail-out need for emergency TPW insertion in patients undergoing RA that have received no upfront TPW insertion.

Methods: We performed a single-centre retrospective study of all patients undergoing RA between October 2009 and October 2022. Patient characteristics, procedural variables, and in-hospital complications were registered.

Results: A total of 331 patients who underwent RA procedure were analysed. No patients underwent prophylactic TPW insertion. The mean age was 73.3 ± 9.1 years, 71.6% (n = 237) were male, while nearly half of the patients were diabetic [N = 158 (47.7%)]. The right coronary artery was the most common target for RA (40.8%), followed by the left anterior descending (34.1%), left circumflex (14.8%), and left main stem artery (10.3%). Altogether 20 (6%) patients required intraprocedural atropine therapy. Emergency TPW insertion was needed in one (0.3%) patient only. Eight (2.4%) patients died, although only one (0.3%) was adjudicated as being possibly related to RA-induced bradycardia. Five patients (1.5%) had ventricular fibrillation arrest, while nine (2.7%) required cardiopulmonary resuscitation. Six (1.8%) procedures were complicated by coronary perforation, two (0.6%) were complicated by tamponade, while 17 (5.1%) patients experienced vascular access complications.

Conclusions: Bail-out transvenous temporary pacing is very rarely required during RA. A standby temporary pacing strategy seems reasonable and may avoid unnecessary TPW complications compared with routine use.

Keywords: bradycardia; complications; conduction disorders; heart block; percutaneous coronary intervention; rotational atherectomy; transvenous temporary pacing.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. GL declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer-review process and the final decision.

Figures

Figure 1
Figure 1
Rotational atherectomy-induced microembolisation can induce reflective bradycardia and transient heart block. There are several procedural aspects, which can limit the occurrence or impact of symptomatic bradycardia.
See this image and copyright information in PMC

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