Thirty-day outcomes of Left Ventricular Pacing during Transcatheter aortic valve implantation: A Systematic review and meta-Analysis
Presenter
Rosa Natalia Cruz Torres, MD, CHI Health Creighton University Medical Center - Bergan Mercy, omaha, NE
Raahat Bansal, MD1, Rosa Natalia Cruz Torres, MD2, Abhishek Thandra, MD1, Shiva Ponamgi, MBBS1, Arun Kanmantha Reddy1 and Venkata M Alla, MD3, (1)CHI Health Creighton University Medical Center, Omaha, NE, (2)CHI Health Creighton University Medical Center - Bergan Mercy, omaha, NE, (3)Creighton University, Omaha, NE
Keywords: TAVI/TAVR/Aortic Valve
Background
Rapid pacing via the right ventricular (RV) pacing is used during transcatheter aortic valve replacement (TAVR). Pacing via retrograde left ventricular (LV) guidewire can be used alternatively. We conducted a meta-analysis to determine outcomes of LV pacing during TAVR.
Methods
PubMed, Google scholar and Cochrane databases were searched for all studies reporting outcomes for patients undergoing TAVR with LV guidewire pacing. Outcomes of interest were procedural success (valve deployment), 30-day all-cause mortality, pacemaker implantation, pericardial tamponade, vascular complications and stroke. Pooled incidence with corresponding 95% confidence intervals (CIs) were calculated using random-effects model.
Results
Six studies met the inclusion criteria with a total of 697 patients. Mean procedure duration was 64.5 +/- 15.3 minutes, with a procedural success rate of 96 % (95% CI 0.87-0.99). Pooled incidence of 30-day all-cause mortality was 3% (95% CI 0.02-0.05). 30-day pooled rates of pacemaker implantation, pericardial tamponade, vascular complications and stroke were 13% (95% CI 0.08-0.19), 1% (95% CI 0.00-0.04), 6% (95% CI 0.03-0.10), and 3% (95% CI 0.02-0.06) respectively. [Figure 1]
Conclusions
The results of our study suggest that pacing via the LV guidewire has a very high procedural success rate. Overall complication rates were low with the use of LV pacing wire and therefore may serve as an alternate to right ventricular pacing, eliminating the need for venous access during TAVR.
