Rapid ventricular pacing: a novel technique to decrease cardiac output for giant basilar aneurysm surgery

Whiteley, Joseph; Payne, Rebecca; Rodriguez-Diaz, César; Ellegala, Dilantha B.; Reeves, Scott

doi:10.1016/j.jclinane.2012.04.013

Cited by 14 publications

(15 citation statements)

References 16 publications

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“…9,44 After its first description in neurosurgery in the 1960s, this technique was abandoned in the 1970s and almost forgotten until 1 small series and 3 case reports reported its successful use in cerebrovascular surgery. 21,30,38,45…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a small series and 3 case reports described the successful use of rapid ventricular pacing (RVP) during aneurysm surgery after subarachnoid hemorrhage (SAH). 21,30,38,45 RVP for flow reduction appears to be a reasonable tool for complex cases. 37,38,45 In contrast to adenosine, RVP allows one to control the start time, the length of pacing, and the induced flow/pressure reduction under controlled conditions.…”

mentioning

confidence: 99%

“…21,30,38,45 RVP for flow reduction appears to be a reasonable tool for complex cases. 37,38,45 In contrast to adenosine, RVP allows one to control the start time, the length of pacing, and the induced flow/pressure reduction under controlled conditions. 36,38 Furthermore, the brain parenchyma is still perfused.…”

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confidence: 99%

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Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial

Konczalla¹,

Platz²,

Fichtlscherer

et al. 2018

Journal of Neurosurgery

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OBJECTIVE To date, treatment of complex unruptured intracranial aneurysms (UIAs) remains challenging. Therefore, advanced techniques are required to achieve an optimal result in treating these patients safely. In this study, the safety and efficacy of rapid ventricular pacing (RVP) to facilitate microsurgical clip reconstruction was investigated prospectively in a joined neurosurgery, anesthesiology, and cardiology study. METHODS Patients with complex UIAs were prospectively enrolled. Both the safety and efficacy of RVP were evaluated by recording cardiovascular events and outcomes of patients as well as the amount of aneurysm occlusion after the surgical clip reconstruction procedure. A questionnaire was used to evaluate aneurysm preparation and clip application under RVP. RESULTS Twenty patients (mean age 51.6 years, range 28-66 years) were included in this study. Electrode positioning was easy in 19 (95%) of 20 patients, and removal of electrodes was easily accomplished in all patients (100%). No complications associated with the placement of the pacing electrodes occurred, such as cardiac perforation or cardiac tamponade. RVP was applied in 16 patients. The mean aneurysm size was 11.1 ± 5.5 mm (range 6-30 mm). RVP proved to be a very helpful tool in aneurysm preparation and clip application in 15 (94%) of 16 patients. RVP was used for a mean duration of 60 ± 25 seconds, a mean heart rate of 173 ± 23 bpm (range 150-210 bpm), and a reduction of mean arterial pressure to 35-55 mm Hg. RVP leads to softening of the aneurysm sac facilitating its mobilization, clip application, and closure of the clip blades. In 2 patients, cardiac events were documented that resolved without permanent sequelae in both. In every patient with successful RVP (n = 14) a total or near-total aneurysm occlusion was documented. In the 1 patient in whom the second RVP failed due to pacemaker electrode dislocation, additional temporary clipping was required to secure the aneurysm, but was not as sufficient as RVP. This led to an incomplete clipping of the aneurysm and finally a remnant on postoperative digital subtraction angiography. A pacemaker lead dislocation occurred in 3 (19%) of 16 patients, but intraoperative repositioning requires less than 20 seconds. Outcome was favorable in all patients according to the modified Rankin Scale. CONCLUSIONS To the best of the authors' knowledge this is the first prospective interdisciplinary study of RVP use in patients with UIAs. RVP is an elegant technique that facilitates clip reconstruction in complex UIAs. The safety of the procedure is good. However, because this procedure requires extensive preoperative cardiological workup of the patient and an experienced neurosurgery and neuroanesthesiology team with much cerebrovascular expertise, actually it remains reserved for selected elective cases and highly specialized centers. Clinical trial registration no.: NCT02766972 (clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial

Konczalla¹,

Platz²,

Fichtlscherer

et al. 2018

Journal of Neurosurgery

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“…More recently, the method has been described as a safe and effective technique to facilitate cerebral aneurysm clip ligation and arteriovenous malformation resection. 14,17 Adenosine-induced cerebral hypotension is another method to temporarily reduce vessel tension in cerebrovascular surgery. Popularized in 2005, this technique effectively induces transient hypotension and facilitates dissection and clip ligation of intracranial aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report

Nimjee¹,

Smith²,

Kanter

et al. 2015

PED

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Large cerebral aneurysms of the basilar apex are difficult to treat. Recently, endovascular treatment has mitigated much of the morbidity associated with treating these lesions. However, the morphology of aneurysms of the vertebrobasilar system can preclude endovascular treatment. Rapid ventricular pacing (RVP) facilitates open surgical treatment of cerebral aneurysms. It can assist in reducing the pressure of the neck of the aneurysm, allowing safe application of a clip. The authors present a case of a pediatric patient who developed a basilar artery pseudoaneurysm that required surgery. Given the large size of the aneurysm, RVP was performed, allowing the surgeons to dissect the dome of the aneurysm from the surrounding tissue and pontine perforating branches away from the lesion to safely clip the lesion. The patient had an uneventful recovery. To the authors' knowledge, this represents the first known case of RVP to aid in basilar artery clip occlusion in a pediatric patient.

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“…valve placement, and neurosurgical procedures such as microsurgical clipping of intracranial aneurysms, resection of brain AVMs, and a case of VGAM. 2,4,[8][9][10][11][12]…”

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confidence: 99%

Rapid cardiac ventricular pacing to facilitate embolization of vein of Galen malformations: technical note

Hockley

Tso

Almekhlafi

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEVein of Galen aneurysmal malformations (VGAMs) in infancy have a poor natural history if left untreated. Their high-flow nature can preclude safe and accurate therapeutic vessel occlusion and the risk of inadvertent pulmonary embolism is predominant. The authors describe the technique of rapid cardiac ventricular pacing for inducing transient hypotension to facilitate the controlled embolization of VGAMs.METHODSInitial transjugular venous access was obtained for placing temporary pacing leads for rapid cardiac ventricular pacing immediately prior to embolization. Definitive transarterial embolization procedures for the VGAMs were then performed in the same setting in which liquid embolic agents or coils were used.RESULTSBeginning in 2010, a total of five procedures were performed in three infants. Transvenous rapid cardiac ventricular pacing was successfully achieved to induce systemic transient flow arrest in all but two attempts, and facilitated partial embolization with n-butyl cyanoacrylate (n-BCA) and coils in all procedures. Ventricular fibrillation occurred twice in one patient and was successfully reversed with defibrillation on both occasions. One patient failed to improve and died from refractory heart failure. Two patients stabilized following staged embolization.CONCLUSIONSRapid transvenous cardiac ventricular pacing can be considered to induce transient hypotension and facilitate controlled embolization in challenging high-flow VGAMs.

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Rapid ventricular pacing: a novel technique to decrease cardiac output for giant basilar aneurysm surgery

Cited by 14 publications

References 16 publications

Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial

Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial

Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report

Rapid cardiac ventricular pacing to facilitate embolization of vein of Galen malformations: technical note

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