Rapid pacing to facilitate transcatheter prosthetic heart valve implantation

Objectives: We describe the technique of, and our experience with, rapid ventricular burst pacing to facilitate transcatheter heart valve implantation. Background: Endovascular therapeutic procedures frequently require the precise placement of implantable devices. The precision of transcatheter device deployment may be hampered by cardiac motion or the effects of intravascular flow. Burst pacing is associated with a reduction in stroke volume, cardiac output, transvalvular flow, and cardiac motion. Methods: Rapid pacing was used in 40 consecutive patients with severe aortic stenosis undergoing implantation of catheter-delivered prosthetic valves. Clinical, procedural, and hemodynamic records were reviewed. Results: A mean of 5 2 burst pacing sequences at rates of 150-220 min(-1) were used during balloon valvuloplasty and valve deployment. The duration of pacing required during valve deployment was 12 +/- 3 sec. Pacing was relatively well tolerated when cautiously used with judicious recovery intervals and pressor support. Rapid pacing was associated with a rapid and effective reduction in systemic blood pressure, pulse pressure, transvalvular flow as well as cardiac and catheter motion. Conclusions: Rapid pacing is a relatively reliable technique to facilitate precise transcatheter deployment of prosthetic heart valves and other endovascular therapeutic devices. (C) 2006 Wiley-Liss, Inc.