Reducing cardiac tamponade caused by temporary pacemaker perforation in transcatheter aortic valve replacement.

Background: Cardiac tamponade caused by temporary right ventricular (RV) pacemaker perforation is a rare but serious complication in transcatheter aortic valve replacement (TAVR).
Aims: To study the incidence of temporary pacemaker related cardiac tamponade in TAVR, and the relation to the type of pacemaker lead used in periprocedural temporary transvenous pacing.
Methods: A single center registry of transfemoral TAVRs in 2014-2020. Main inclusion criterion was peri-operative use of a temporary RV pacing lead. Main exclusion criteria were a preoperatively implanted permanent pacemaker or the exclusive use of left ventricular guidewire pacing. Incident cardiac tamponade was classified as pacemaker lead related, or other. Patients were grouped according to type of temporary RV pacing wire.
Results: 810 patients were included (age 80.5 ± 7.3 [mean ± standard deviation], female 319, 39.4%). Of these, 566 (69.9%) received a standard RV temporary pacing wire (RV-TPW), and 244 (30.1%) received temporary RV pacing through a permanent, passive pacemaker lead (RV-TPPL). In total, 18 (2.2%) events of cardiac tamponade occurred, 12 (67%) were pacemaker lead related. All pacemaker lead-related cardiac tamponades occurred in the group who received a standard RV-TPW and none in the group who received RV-TPPL (n = 12 [2.1%] vs. n = 0 [0%], p = 0.022). No difference in cardiac tamponade due to other causes was seen between the groups (p = 0.82).
Conclusions: The use of soft-tip RV-TPPL was associated with a lower risk of pacemaker related cardiac tamponade in TAVR. When perioperative pacing is indicated, temporary RV-TPPL may contribute to a significant reduction of cardiac tamponade in TAVR.
Competing Interests: Declaration of Competing Interest Dr. Feldt has received consulting/speaker fees from Abbott Vascular, Astra Zeneca, Anteris Technologies and Alleviant Medical. Dr. Dalén, Dr. Kastengren, Dr. Hörnsten, and Dr. Omar report no relationships that could be construed as a conflict of interest. Dr. Rück has served as a proctor for Boston Scientific and has received consulting fees from Medtronic and Edwards. Dr. Meduri has received consulting fees from Boston Scientific, Abbott Vascular, Cardiovalve, Vdyne, Alleviant and Anteris Technologies. Dr. Saleh and Dr. Linder report no relationships that could be construed as a conflict of interest. Dr. Settergren has served as a proctor for Boston Scientific, Abbott Vascular and has received consulting fees from Medtronic, Anteris Technologies, Holistic Medical, Cardiomech and Teleflex.
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)