# Reduced ejection fraction as the sole potential limitation for wire pacing in transfemoral aortic valve replacement

## TL;DR

A new pacing technique during heart valve replacement is safe and effective, but may not work well for patients with weak heart function.

## Contribution

Demonstrates the safety and efficacy of left ventricular wire pacing during TAVI, identifying reduced ejection fraction as a key limitation.

## Key findings

- Left ventricular pacing was successful in 93.8% of cases.
- Reduced ejection fraction (LVEF <52%) predicted pacing failure.
- Wire pacing had low complication rates and comparable safety to traditional methods.

## Abstract

In recent years, fast-track protocols have been developed for transcatheter aortic valve replacement/implantation (TAVR/TAVI) to further simplify the procedure. Traditionally, intraprocedural rapid ventricular pacing for valve deployment is achieved via a transvenous temporary pacing wire inserted into the right ventricle.

The aim of the present study was to assess the safety and efficacy of a temporary left ventricular pacing (wire pacing) technique during the TAVI procedure.

In this prospective observational study, 307 consecutive patients undergoing TAVI with either the Edwards SAPIEN S3 (N = 161; 52.4%) or the Medtronic Evolut Pro+ (N = 146; 47.6%) were included. Left ventricular pacing was performed using the valve delivery guidewire. The primary endpoint was defined as successful rapid pacing. Safety outcomes and both qualitative and quantitative secondary endpoints were also analyzed and compared to those of a conventional previous TAVI cohort that received transvenous right ventricular pacing.

Left ventricular pacing was successful in 93.8% of cases (n = 288). Moreover, 16 patients (5.4%) required a temporary pacing wire during the procedure due to complete heart block. Procedural success of TAVI was achieved in 98.0% of patients (n = 294). Periprocedural complications were low and included an in-hospital death rate of 1.6%, major bleeding in 1.3% of patients, and permanent pacemaker implantation in 10.2% of patients following TAVI. No incidence of cardiac perforation or tamponade was observed. Safety outcomes were comparable to those of the conventional right ventricular pacing group. Reduced left ventricular ejection fraction (LVEF) was significantly associated with unsuccessful left ventricular guidewire pacing (p = 0.036). An LVEF cutoff of <52% best predicted left ventricular stimulation failure (area under the curve 0.632, sensitivity 63.2%, specificity 63.8%, p = 0.045).

Wire pacing is safe and effective, should be preferred for TAVI, and eliminates the risk of complications associated with transvenous pacing wires. Nonetheless, caution is advised when using this technique in patients with reduced ejection fraction or a high risk of conduction disorders.

Advantages and limitations of wire pacing in TAVI.

Advantages and limitations of wire pacing in TAVI.