title: Rapid ventricular pacing for flow arrest during cerebrovascular surgery:  revival of an old concept.
abstract: BACKGROUND
  Intraoperative rupture of a cerebral aneurysm can be a devastating event that increases operative morbidity and mortality. Rapid ventricular pacing (RVP) is a technique used in interventional cardiology to obtain flow arrest for short periods of time.
  
  
  OBJECTIVE
  To present our experience using RVP for flow arrest during cerebrovascular surgery.
  
  
  METHODS
  We used RVP to produce flow arrest for periods of 40 seconds in 12 patients who underwent craniotomy for a cerebrovascular disorder (11 aneurysms and 1 arteriovenous malformation).
  
  
  RESULTS
  During RVP, there was an immediate and significant reduction of blood pressure in each patient. The maximum degree of hypotension was obtained 3.2 ± 0.7 seconds (mean ± SD) after the start of RVP. When RVP was terminated, normal sinus rhythm returned instantaneously, along with recovery of indexes of hemodynamic function. Subjectively, the decrease in blood pressures facilitated dissection, and during clipping, the aneurysm sac felt softer and was easier to manipulate. No complications related to RVP occurred.
  
  
  CONCLUSIONS
  Rapid ventricular pacing during cerebrovascular surgery is an effective method for lowering the arterial blood pressure in a controlled and directly reversible manner. Advances in cardiology now make RVP a promising and safe technique that can facilitate complex cerebrovascular surgery.
authors.affiliation: Department of Anesthesiology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Vera
authors.initials: V
authors.lastname: Saldien
authors.forename: Tomas
authors.initials: T
authors.lastname: Menovsky
authors.forename: Margo
authors.initials: M
authors.lastname: Rommens
authors.forename: Gregory
authors.initials: G
authors.lastname: Van der Steen
authors.forename: Katrin
authors.initials: K
authors.lastname: Van Loock
authors.forename: Gaelle
authors.initials: G
authors.lastname: Vermeersch
authors.forename: Chris
authors.initials: C
authors.lastname: Mott
authors.forename: Johan
authors.initials: J
authors.lastname: Bosmans
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ridder
authors.forename: Andrew I R
authors.initials: AI
authors.lastname: Maas
mesh_terms: D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D055815:Young Adult