Direct left ventricular wire pacing during transcatheter aortic valve implantation.

Background Rapid ventricular pacing is used during balloon aortic valvuloplasty, balloon-expandable transcatheter aortic valve implantation (TAVI) and for post-dilatation. Traditionally, the right ventricular (RV) lead pacing has been a gold standard. Direct left ventricular (LV) wire pacing has recently been considered safe and effective in TAVI interventions. Aims The study aimed to analyze procedural outcomes of direct LV pacing compared to RV stimulation in unselected TAVI patients. Methods Direct LV wire pacing was provided via available pre-shaped guidewires and used only when no predictors of the atrioventricular block were present. The primary objective was the assessment of the efficacy of direct LV wire pacing. The secondary objectives were the appraisal of procedure duration and safety in comparison with the conventional method. A combined endpoint (MACE) consisting of death, stroke, venous puncture complications, and cardiac tamponade was defined. Results In 2017 and 2018, 143 patients underwent transfemoral TAVI. Of these, 114 (79.7%) had self-expandable valves implanted. Direct LV wire pacing was the dominant method of pacing (82 patients, 57.3%), and its efficacy was 97.6%. The procedural duration [IQR] was shorter in the direct LV wire pacing group (80 [70-90] vs. 85 [70-95] min, P = 0.02). MACE event was more frequent in the RV lead pacing group (11.5% vs. 4.9%), but no statistical significance was achieved (P = 0.13). Conclusions Direct LV wire pacing during TAVI is simple, reproducible, and safe technique that provides a reliable, sustained stimulation with low rate of complications and potential reduction of procedural time.