title: Tolerance of rapid right ventricular pacing during thoracic endovascular aortic repair.
abstract: BACKGROUND
  The objective of this retrospective study was to evaluate the tolerance of rapid right ventricular pacing (RRVP) compared with that of the traditional methods of hypotension used during thoracic endovascular aortic repair (TEVAR).
  
  
  METHODS
  From January 2002 to December 2012, we retrospectively included all the patients treated with TEVAR by comparing the 2 groups: patients operated with RRVP (RRVP+) and those operated without RRVP (RRVP-). The characteristics of the population and the procedures were recorded. The rates of complications were compared up to 1 year.
  
  
  RESULTS
  Sixty-one patients were operated. Treated pathologies were multiple with 19 aneurysms, 14 false aneurysms, 12 isthmic ruptures, 11 dissections, 3 coarctations, and 2 endoleaks. Twenty-four patients were RRVP+ and 37 patients were RRVP-. Mortality rates at 1 month in groups RRVP+ and RRVP- were of 0% and 2.7%, respectively (P = 1), and reintervention rates were 0% and 13.5%, respectively (P = 0.15). Three peroperative rhythm disorders (12.5%) were observed in the RRVP+ group including 2 ventricular fibrillations and 1 atrial fibrillation, both reduced without complications. One pacemaker was implanted for atrioventricular block in the RRVP- group. In the RRVP+ group, 83.3% of the patients presented a rise in troponin Ic (TnI) >0.04 ng/mL in 72 hours compared with 40.5% of the patients in the RRVP- group (P = 0.0013), with a spontaneously favorable evolution. No coronary syndrome was observed at 1 year with a mortality rate of 10.8% in the RRVP- group vs. 0% in the RRVP+ (P = 0.15).
  
  
  CONCLUSIONS
  In spite of a frequent moderate rise of TnI at the time of RRVP, this technique does not present more complications at 1 year than the use of a chemical hypotension. It thus seems an interesting alternative for selected patients, in trained teams.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Tours, Tours, France. Electronic address: pierrelhommet@gmail.com.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lhommet
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Tours, Tours, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Espitalier
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Tours, Tours, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Merlini
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Tours, Tours, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Marchand
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Tours, Tours, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Aupart
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Tours, Tours, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Martinez
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D016278:Ventricular Function, Right
chemical_list: D015415:Biomarkers; D019210:Troponin I; D009529:Nicardipine