Left ventricular (LV)-stimulation via a guidewire significantly reduced procedure duration, fluoroscopy time, and cost, while maintaining similar efficacy and safety compared with standard right ventricular (RV)-stimulation, according to findings presented Sept. 25 at TCT 2019 and simultaneously published in JACC: Cardiovascular Interventions.

Benjamin Faurie, MD, et al., randomly assigned 307 patients undergoing transfemoral TAVI with a Sapien valve to either LV- (n=151) or RV-stimulation (n=152) between May 2017 and May 2018. The primary endpoint was procedure duration, while secondary endpoints included efficacy, safety and cost at 30 days.

Overall results found mean procedure duration was significantly shorter in the LV-stimulation group (48.4 ± 16.9 vs. 55.6 ± 26.9 min), with a difference of -0.12 (95 percent CI -0.20 to -0.05) in the log transformed procedure duration. Efficacy and safety were similar in the LV- and RV-stimulation groups. Researchers did note fluoroscopy time was lower in the LV-stimulation group (13.48 ± 5.98 vs. 14.60±5.59, along with cost (€18,807 ± 1,318 vs. €19,437 ± 2,318, p=0.001).

"By eliminating the need for a transvenous temporary pacing lead or additional venous access in most cases, LV-stimulation succeeded in simplifying the TAVI procedure and should be considered as the default strategy for rapid ventricular pacing," suggest Faurie and colleagues.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: TCT19, Transcatheter Cardiovascular Therapeutics, Angiography

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