title: Rapid pacing using the left ventricular guidewire: Reviving an old technique to simplify BAV and TAVI procedures.
abstract: OBJECTIVE
  We sought to demonstrate the safety and efficacy of rapid left ventricular (LV) pacing through the guidewire during balloon aortic valvuloplasty (BAV) and Transaortic valve implantation (TAVI).
  
  
  BACKGROUND
  Right ventricular temporary pacing during TAVI and BAV is time-consuming and associated with vascular and pericardial complications.
  
  
  METHODS
  Rapid left ventricular pacing was provided via the back-up 0.035″ guidewire. The cathode of an external pacemaker was placed on the tip of the 0.035″ wire and the anode on a needle inserted into the groin. Insulation was ensured by the balloon or TAVI catheter.
  
  
  RESULTS
  38 BAV and 87 TAVI procedures were performed in 113 consecutive patients in three centers with one for one pacing (160-200 bpm) in all patients. A significant reduction in blood pressure was achieved with a mean systolic pressure of 44 mm Hg during stimulation. Mean procedural time was 49.7 ± 31 min for BAV and 68.7 ± 30.9 for TAVI. A temporary venous pacemaker was required in 12 patients; only 12% of TAVI patients had a femoral central venous catheter. Femoral venous puncture was not performed in BAV patients. No venous vascular complications were observed. One case of successfully treated tamponade (0.8%) occurred 8 hr post procedure. In-hospital mortality rates were 4.6% and 2.6% in the TAVI and BAV groups, respectively.
  
  
  CONCLUSIONS
  Use of the LV guidewire for rapid pacing during BAV and TAVI was shown to be simple, reproducible, and prevented complications associated with RV temporary leads thus potentially simplifying TAVI and enhancing its safety. © 2016 Wiley Periodicals, Inc.
authors: Groupe Hospitalier Mutualiste, Institut Cardio-Vasculaire de Grenoble, Grenoble, France.
authors: Benjamin
authors: B
authors: Faurie
authors: Groupe Hospitalier Mutualiste, Institut Cardio-Vasculaire de Grenoble, Grenoble, France.
authors: Mohamed
authors: M
authors: Abdellaoui
authors: Clinique Du Tonkin, Villeurbanne, Lyon, France.
authors: Fabrice
authors: F
authors: Wautot
authors: Clinique Du Tonkin, Villeurbanne, Lyon, France.
authors: Patrick
authors: P
authors: Staat
authors: Clinique Du Tonkin, Villeurbanne, Lyon, France.
authors: Didier
authors: D
authors: Champagnac
authors: Groupe Hospitalier Mutualiste, Institut Cardio-Vasculaire de Grenoble, Grenoble, France.
authors: Jérome
authors: J
authors: Wintzer-Wehekind
authors: Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
authors: Gérald
authors: G
authors: Vanzetto
authors: Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
authors: Bernard
authors: B
authors: Bertrand
authors: Groupe Hospitalier Mutualiste, Institut Cardio-Vasculaire de Grenoble, Grenoble, France.
authors: Jacques
authors: J
authors: Monségu
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis; D063126:Balloon Valvuloplasty / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: TAVI; balloon aortic valvuloplasty; rapid pacing