Author + information
- S1936879815020415-3c8820a61a63b2f0651014459e638d70Evan Shlofmitz1,
- S1936879815020415-a32592b33f8e4d96f50c3ba1dc90e3fbJeffrey Chambers2,
- S1936879815020415-8a36f571af66478e279c30b0738b1326Michael Lee3,
- S1936879815020415-b70a4a0786e5e18e5376510610e4da94Jeffrey Moses4,
- S1936879815020415-232319ee99b9b6ed531b06bae603f3e0Brad Martinsen5,
- S1936879815020415-3193e818e24711c02a66c2f426f2c237Perwaiz Meraj1,
- S1936879815020415-217bab22e795dc20550a3289d1b3bcf1Rajiv Jauhar1 and
- S1936879815020415-e947bcd0389a23a8b5a259468f095cbdRichard Shlofmitz4
Transvenous temporary pacing (TVP) is often used during percutaneous coronary intervention (PCI) in patients undergoing rotational atherectomy (RA) and is recommended for prophylactic use in all cases involving the RCA. The placement of transvenous pacing has cost implications, but more importantly is associated with increased procedural risk. Diamondback 360® Coronary Orbital Atherectomy System (OAS) is a device which can treat calcific coronary artery disease (CAD) as an alternative to RA. Due to the difference in the mechanism of atherectomy, OAS may not require TVP as compared to RA. The objective of this study is to identify if there is a difference in utilization of temporary transvenous pacemaker‘s during PCI with OAS compared with RA in a multi-center real world setting.
A multi-center retrospective analysis was completed on all PCI cases that took place at five institutions between January 2012 and June 2015, using either OAS or RA (n=823). We assessed the number of cases in which TVP were placed, and subsequently activated. Statistical analysis was performed using the Chi-square test.
There were 439 cases utilizing OAS, of which 17 cases had TVP placed (3.87%), with 4 pacemakers activated. During orbital atherectomy, 12 of the TVP's were for RCA cases, 2 for LCx and 3 for LAD. There were 384 rotational atherectomy cases, with 44 TVP's placed (11.5%), with 17 activated. 37 of the TVP's placed with RA were for RCA cases, 4 for LCx, 2 for LAD and 2 for LM. TVP's were placed significantly less often in OAS cases as compared with RA cases (p-value = 0.00003). Pacemaker activation occurred significantly less in the OAS cohort (p-value = 0.001).
Guidelines have suggested that TVP's may be necessary when treating lesions in the right coronary (RCA) and dominant circumflex (LCx) arteries with OAS. This however is based on data involving RA. In a real world setting, temporary pacemakers were placed significantly less for OAS cases as compared to RA cases. OAS has a different mechanism of action which likely accounts for lower rates of arrhythmia, particulate embolization, no reflow phenomenon and hemodynamic changes compared with RA. These factors may lead to decreased need for TVP during OAS cases, as it appears to less frequently cause the Bezold-Jarisch reflex associated with dominant RCA or LCx atherectomy. Further studies are needed to determine whether TVP's are routinely needed for OAS cases.