A longer total duration of rapid ventricular pacing does not increase the risk of postprocedural myocardial injury in patients who undergo transcatheter aortic valve implantation

Abstract

Rapid ventricular pacing (RVP) is used during transcatheter aortic valve implantation (TAVI). RVP disturbs myocardial oxygen balance, and when prolonged, it may cause procedure-related myocardial injury (PMI). This study investigated whether a longer duration of RVP increased the occurrence of PMI or worsened long-term mortality after TAVI. We retrospectively analyzed data from 188 patients who underwent TAVI in our institute from January 2013 to July 2015. Myocardial injury was represented by the peak value of creatine kinase-myocardial band (CK-MB) within 72 h after the procedure; an increase greater than 5 times the upper reference limit was regarded as PMI. There was no difference in RVP time (RVPT) between patients with and without PMI (median [range]: 57 [9-189] s vs. 54 [0-159] s, p = 0.9). A higher peak CK-MB was significantly correlated with the apical approach for the procedure (p < 0.001) but not with total RVPT (p = 0.22). A subanalysis of 133 patients whose troponin I was tested within 72 h postprocedurally showed no correlation between the peak value and RVPT (p = 0.40). Shortening RVPT did not result in myocardial protection; thus, RVPT during TAVI should be sufficient to optimize valve placement.

Early hemodynamic changes after transcatheter aortic valve implantation in patients with severe aortic stenosis measured by invasive pressure volume loop analysis

“…As a result, cardiac output drops and causes transient coronary hypoperfusion and systemic hypotension, a condition that can lead to myocardial stunning [33]. Following TAVI cardiac biomarkers sensitive for myocardial injury increase and are valid surrogates for poor long-term outcomes [32,33]. But interestingly, the duration of rapid ventricular pacing itself seems to have no relevant correlation with periprocedural myocardial injury, defined by the elevation of ischemic markers [32].…”

Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement

“…As with any hypotensive period, RVP may have adverse clinical impact. However, even though RVP is routinely performed during the majority of TAVR procedures, current data on the clinical impact of RVP during TAVR are limited to small numbers of patients with surrogate end points 1, 2, 4, 7. Few studies have correlated RVP with a clinical end point.…”

“…Okitsu et al assessed correlation between RVP and elevation in myocardial biomarkers4 and found good correlation between duration of RVP and elevation of myocardial biomarkers, however, once corrected to TAVR approach (ie, femoral versus apical) no significant correlation was found between pacing duration and elevation in myocardial biomarkers. Indeed prior studies have shown that transapical approach is associated with higher levels of cardiac enzymes 9.…”

“…Indeed, prior case reports and small‐scale studies have reported conflicting data on the hemodynamic effects and clinical impact of RVP during TAVR 1, 2, 3, 4. Thus the aim of the present study was to assess the clinical impact of RVP on immediate and long‐term outcomes in a large cohort of non‐selected TAVR patients.…”

Methods for prevention of intraoperative rupture during surgical interventions of intracranial aneurysm clipping

“…В 2017 г. K. Okitsu et al [106] опубликовали исследование, посвященное изучению влияния продолжительности проведения RVP на интраоперационное ишемическое повреждение миокарда и послеоперационную летальность. Обследованы 188 пациентов, которым проводили транскатетерное протезирование аортального клапана (trans-catheter aortic valve implantation, TAVI).…”