Does Rapid Pacing During Balloon TAVR Cause RV Issues?

Rapid pacing during transcatheter aortic valve replacement (TAVR) with balloon-expandable devices was tied to right ventricular (RV) dysfunction thereafter, a study suggested.

RV diastolic dysfunction was apparent after rapid pacing to test capture and subsequent valve deployment: RV tau went from 58.0 ms at baseline to 72.3 ms (P=0.003) post-pacing and even reached 80.1 ms after valve deployment (P<0.001), according to the study in the Journal of the American College of Cardiology.

Those with normal baseline RV function and RV dysfunction alike were impaired from rapid pacing, noted Stephen P. Hoole, DM, of Papworth Hospital NHS Foundation Trust in the U.K., and colleagues.

"Those with normal RV function at baseline were not spared, and there was no minimum 'safe' threshold of rapid pacing below which RV dysfunction did not occur. These observations are important because RV dysfunction independently predicts 1-year mortality after TAVR," the researchers suggested.

"TAVR at best does not appear to improve RV function and may even result in RV failure ... Our study provides a plausible and potentially avoidable mechanism. It remains to be elucidated whether TAVR without rapid pacing may preserve RV function, further improving TAVR results."

Their study included 22 high-risk TAVR patients who all had successful device implantation via femoral access. All received balloon-expandable Sapien XT and Sapien 3 valves during rapid pacing.

"We have established that rapid pacing during balloon-expandable TAVR implantation causes RV dysfunction that was apparent and near maximal after a relatively short period of rapid pacing [to test capture] and before TAVR," Hoole's group concluded. "This persisted post-TAVR."

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