Temporary transcoronary pacing by coated guidewires

Abstract

Relevant bradycardias during percutaneous coronary intervention (PCI) are a rare event, but they require immediate therapy by temporary pacing. However, transvenous pacing is associated with frequent and severe complications. Therefore, we wanted to evaluate the safety and reliability of trans-coronary pacing by means of a PCI guidewire. Coronary pacing was applied to 70 consecutive patients undergoing PCI. Pacing was performed before and after PCI in a unipolar setting using standard guidewires as a cathode and a skin electrode as an anode. Both were connected to an external pacemaker. Coronary pacing (maximum output at 10 V, impulse duration 2.5 ms) was effective in 60 of 70 patients (85.7%). Successful pacing was achieved in the LAD and diagonal branches in 90% (27 of 30 Pts.), in the LCX and marginal branches 84.2% (16 of 19 Pts.) and in the RCA in 81% (17 of 21 Pts.). Pacing thresholds were comparable in all vessels within a range of 1-10 V averaging 6.6 +/- 2.3 V before and 6.6 +/- 2.2 V after PCI. The impedance ranged from 190-544 Omega with mean pacing impedance for coronary pacing of 424 Omega before and 416 Omega after PCI, respectively. Significant bradycardias during PCI occurred in 7 cases (10%). In three cases (4.3%) temporary coronary pacing became necessary at a maximum pacing duration of 3 min. There were no severe side effects. Coronary spasm occurred in 3 cases (4.3%) after pacing and was promptly reversible after intracoronary application of nitroglycerine. It is concluded that coronary pacing is a safe and feasible method for the treatment of bradycardias during PCI. It avoids additional venous puncture under hemodynamically unstable conditions and subsequent transvenous pacing, which is accompanied by potentially severe complications and additional costs.

Intracoronary Pacing during “Chimney Technique” in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation?

“…IC-TRVP, with or without over-the-wire balloon coverage, has been previously described in animal models too [ 7 , 8 ]. In 2022, Heinroth et al published their successful IC-TRVP experience with a double-wire technique in pig models, using a polytetrafluoroethylene-covered guidewire in the proximal segment of the vessel serving as indifferent anode, and another standard guidewire, advanced into the periphery of the same coronary artery and covered with a coronary balloon, as cathode [ 9 ].…”

“…Pacing was achieved in 40 different coronary tracts; each site of IC stimulation was then compared to the corresponding tributary areas at cardiac magnetic resonance and to the presence, in the same segments, of an epicardial coronary stenosis ≥50%: the evidence of a myocardial scar without any stenosis reducing the coronary lumen more than 50% had significantly different conductance parameters during IC-TRVP [ 12 ]. In 2006, Heinroth et al reported a successful LAD IC-TRVP in 90% of a total of 30 patients undergoing PCI, with low risk of transient coronary spasm [ 13 ]. Recently, Mallek et al reported a case of PCI of a right coronary artery ostial lesion in which IC-TRVP allowed precise stent positioning and implantation [ 14 ].…”

Coronary Guidewires in Temporary Cardiac Pacing and Assessment of Myocardial Viability: Current Perspectives and Future Directions

“…The concept of cardiac pacing using a coronary artery guide wire was first investigated in 1984 by Chatelain et al who demonstrated that short term cardiac pacing via a coronary guidewire was achievable and well tolerated in a swine model [9]. Later, Heinroth et al performed a study to determine the effect of electrical insulation of the guidewire on pacing parameters during TCP [10]. Insulation using an angioplasty balloon catheter increased the success rate of myocardial capture from 77% to 100%.…”