Rapid right ventricular pacing is an alternative to adenosine in catheter interventional procedures for congenital heart disease

Objective: To describe the use of rapid right ventricular pacing to facilitate balloon stability during balloon dilatation procedures for congenital heart disease. Setting: Tertiary paediatric cardiac centre. Design and patients: This was a prospective pilot study of 37 consecutive patients with congenital aortic stenosis undergoing elective balloon dilatation. If the first dilatation manoeuvre failed due to balloon displacement, rapid right ventricular pacing at a rate of 220 beats/min was performed during repeat balloon inflation. Interventions: Balloon aortic valvotomy and rapid right ventricular pacing. Main outcome measures: Balloon stability versus displacement during balloon dilatation and procedure related complications. Results: Initial balloon displacement occurred and rapid right ventricular pacing was performed in 14 patients. The balloon remained in stable position in 11 patients. In three patients the balloon was displaced. In two of them an increase of the pacing rate to 240 beats/min provided balloon stability. In one patient stability was obtained at an unchanged pacing rate after correction of a suboptimal balloon position. No sustained arrhythmias occurred. There were no other procedure related complications. Conclusions: Rapid right ventricular pacing is a safe and effective method to provide balloon stability during balloon dilatation of the aortic valve. It may be applied in other fields of catheter intervention where it is desirable to maintain stable device positions during the critical phase of the procedure.