Author + information
- Hoyle L. Whiteside III,
- Supawat Ratanapo,
- Tarun Sharma,
- Arun Nagabandi and
- Deepak Kapoor
Bradycardia is a known complication of rotational atherectomy (RA). The manufacturer of the Rotablator system (Boston Scientific, MA) recommends placement of a temporary pacing wire in patients undergoing RA of lesions in the right coronary artery (RCA) and/or dominant left circumflex artery (LCx). No formal guideline recommendations exist in this setting and the utility of prophylactic temporary pacing wire placement remains controversial.
We retrospectively identified all patients undergoing RA with target lesions in the RCA and/or LCx over a two-year period. Chart review was performed and data regarding patient demographics, procedural characteristics, and temporary pacing wire utility were collected.
Sixty patients met inclusion criteria for our study. Demographic data and procedural characteristics are reported in Table 1. TIMI 3 flow was achieved in 60 (100%) cases. A temporary pacing wire was placed in 9 (15%) cases. No occurrences of hemodynamically significant bradycardia were reported in the remaining 51 (85%) cases.
While bradycardia is a known complication of RA to RCA and LCx, prophylactic placement of a temporary pacing wire is an operator-dependent decision. In our population, bradycardia requiring temporary pacing was not a common occurrence and the majority of cases did not require a temporary pacing wire. In addition to routine defibrillation pad placement, we recommend routine insertion of an appropriate central venous access sheath without placement of a prophylactic pacing wire in patients undergoing RA to RCA or LCx, should emergent pacing be required.