Bail-out transvenous temporary pacing during rotational atherectomy PCI - a single center experience

BackgroundRotational atherectomy (RA) percutaneous coronary intervention (PCI) may cause transient bradycardia or heart block. Traditionally, some operators use prophylactic transvenous pacing wire (TPW) to avoid haemodynamic complications associated with bradycardia. We sought to establish the frequency of bail-out need for emergency TPW insertion in patients undergoing RA PCI that have received no upfront TPW insertion. MethodsWe performed a single-centre retrospective study of all patients undergoing RA PCI between October 2009 and October 2022. Patient characteristics, procedural variables and in-hospital complications were registered. ResultsA total of 331 patients who underwent RA procedure were analyzed. No patients underwent prophylactic TPW insertion. The mean age was 73.3{+/-}9.1 years, 71.6% (n=237) were male, while nearly half of patients were diabetic (N=47.7%, N=158). The right coronary artery was the most common target for RA PCI (40.8%), followed by left anterior descending (34.1%), left circumflex (14.8%) and left main stem artery (10.3%). Twenty (6%) of patients required intraprocedural atropine therapy. Emergency TPW insertion was needed in one patient (0.3%) only. Eight (2.4%) patients died, however only one was adjudicated as possibly related to RA-induced bradycardia. Five patients (1.5%) had ventricular fibrillation arrest while nine (2.7%) required cardiopulmonary resuscitation. Six (1.8%) procedures were complicated by coronary perforation, two (0.6%) were complicated by tamponade while 17 (5.1%) patients experienced vascular access complications. ConclusionsBail-out transvenous temporary pacing is very rarely required during RA PCI. A standby temporary pacing strategy is reasonable and may avoid unnecessary TPW complications compared to routine use.