Transcutaneous temporary cardiac pacing in carotid stenting: noninvasive prevention of angioplasty-induced bradycardia and hypotension.
OBJECTIVE
To evaluate the feasibility, safety, and effectiveness of prophylactically placed noninvasive transcutaneous temporary pacemakers (NTP) to prevent angioplasty-induced bradycardia and hypotension during carotid angioplasty and stenting (CAS).


METHODS
The preventive use of NTPs was evaluated in 31 CAS procedures performed at 3 institutions in 30 patients considered to be at high risk for developing angioplasty-induced bradycardia. Twenty-four cases in 23 patients (20 men; mean age 72 years, range 56-85) requiring intraprocedural pacing due to angioplasty-induced bradycardia were included in this study. Pacemakers were set to capture a heart rate <60 beats/min based on the basal heart rate.


RESULTS
Noninvasive pacing was technically effective in producing electrical ventricular responses and was hemodynamically effective in most patients. All patients were easily and comfortably stimulated at amplitudes <50 mA (usually 30). There were no complications related to either pacemaker placement or performance.


CONCLUSIONS
The prophylactic use of a noninvasive transcutaneous pacemaker for expected bradycardia during CAS appears to be safe and effective in preventing intraprocedural bradycardia and hypotension, with a decrease in additional pharmacological support during the procedures.
Im
So-Hyang
SH
Department of Neurosurgery, Dongguk University Hospiutal, Gyeonggido, Korea.
Han
Moon Hee
MH
Kim
Sung Hyun
SH
Kwon
Bae Ju
BJ
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D001919:Bradycardia / Q000209:etiology / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D016893:Carotid Stenosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome