0015: Left ventricular rapid pacing: a new technique to simplify BAV and TAVI procedures

AimsThe aim of this study is to demonstrate efficacy and safety of a new technique for rapid pacing during balloon aortic valvuloplasty (BAV) and Transaortic Valve Implantation (TAVI).This study first describes the method used safely and successfully for BAV and TAVI in a fragile adult population.Methods and results these technique consist in a left ventricular pacing through the 0.35 inch back up guidewire inserted into the left ventricule. The cathode of an external pacemaker was placed on the external end of the 0.35’ wire using an alligator clamp. The anode was placed (also using an alligator clamp) on a small needle piercing the subcutaneous tissue at the site of the anesthetized groin.The balloon or the TAVI catheter provides the necessary insulation.We performed consecutively 100 cases of BAV and TAVI. All cases were successfully conducted with a one for one pacing (160 to 200/mn). That’s how we obtain a significant blood pressure drop in all cases with a mean systolic pressure during stimulation of 45mmHg. The time procedure was 38mn for BAV and 65mn for TAVI. Only three patients underwent a venous temporary pacemaker at the end of procedure for conduction disturbances. All cases of TAVI (34) underwent a femoral venous catheter as a central catheter while the BAV population did not have a venous femoral puncture. No venous vascular complication or tamponade was observed in our population.ConclusionsThis study demonstrated that the rapid pacing trough the back-up left ventricle guidewire is equivalent to right ventricular pacing in term of efficacy.This method is safer due to the limitation of complications related to right ventricular pacing lead placement. Finally, it simplify the procedure by making it faster