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

Kari Feldt; Magnus Dalén; Christopher U Meduri; Mikael Kastengren; Jessica Bager; Jonas Hörnsten; Aninda Omar; Andreas Rück; Nawzad Saleh; Rickard Linder; Magnus Settergren

doi:10.1016/j.ijcard.2023.01.015

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

Int J Cardiol. 2023 Apr 15:377:26-32. doi: 10.1016/j.ijcard.2023.01.015. Epub 2023 Jan 11.

Authors

Affiliations

¹ Department of Medicine, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. Electronic address: kari.feldt@ki.se.
² Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
³ Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
⁴ Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
⁵ Department of Cardiothoracic Surgery, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
⁶ Department of Medicine, Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.

PMID: 36640966
DOI: 10.1016/j.ijcard.2023.01.015

Abstract

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.

Keywords: Cardiac tamponade; Conduction abnormalities; Femoral; Miscellaneous; TAVI; Temporary pacing.

MeSH terms

Aged
Aged, 80 and over
Aortic Valve / surgery
Aortic Valve Stenosis* / surgery
Cardiac Pacing, Artificial
Cardiac Tamponade* / diagnosis
Cardiac Tamponade* / epidemiology
Cardiac Tamponade* / etiology
Female
Humans
Pacemaker, Artificial* / adverse effects
Risk Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome