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Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I Interleukin-1 Beta as a Target for Atherosclerosis Therapy: Biological Basis of CANTOS and Beyond Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study Application of High-Sensitivity Troponin in Suspected Myocardial Infarction No causal effects of plasma homocysteine levels on the risk of coronary heart disease or acute myocardial infarction: A Mendelian randomization study Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association Validation of High-Risk Features for Stent-Related Ischemic Events as Endorsed by the 2017 DAPT Guidelines Ejection Fraction Pros and Cons: JACC State-of-the-Art Review Open sesame technique in percutaneous coronary intervention for ST-elevation myocardial infarction Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association

Clinical TrialSeptember 2019

JOURNAL:JACC Cardiovasc Interv. Article Link

Left Ventricular Rapid Pacing Via the Valve Delivery Guidewire in Transcatheter Aortic Valve Implantation

B Faurie, G Souteyrand, the EASY TAVI investigators. Keywords: left-ventricular stimulation; left-ventricular pacing; transcatheter aortic valve implantation; transcatheter aortic valve replacement

ABSTRACT


BACKGROUND - Rapid ventricular pacing is necessary to ensure cardiac standstill during transcatheter aortic valve implantation (TAVI).

 

OBJECTIVES - We investigated whether left ventricular (LV)-stimulation via a guidewire reduced procedure duration while maintaining efficacy and safety compared with standard right ventricular (RV)-stimulation.

 

 

METHODS - This is a prospective, multicenter, single-blinded, superiority, randomized controlled trial. Patients undergoing transfemoral TAVI with a Sapien valve (Edwards Lifesciences) were allocated to LV- or RV-stimulation. The primary endpoint was procedure duration. Secondary endpoints included efficacy, safety, and cost at 30 days. This trial is registered at clinicaltrials.gov (NCT02781896).

 

RESULTS - Between May 2017 and May 2018, 307 patients were randomised but 4 were excluded because they did not receive the intended treatment: 303 patients were analysed in the LV- (n=151) or RV-stimulation (n=152) groups. Mean procedure duration was significantly shorter in the LV-stimulation group (48.4±16.9 vs. 55.6±26.9 min, p=0.0013), with a difference of -0.12 (95% CI -0.20 to -0.05) in the log transformed procedure duration (p=0.0012). Effective stimulation was similar in the LV- and RV-stimulation groups: 124 (84.9%) vs. 128 (87.1%), p=0.60. Safety of stimulation was also similar in the LV- and RV-stimulation groups: procedural success occurred in 151 (100%) vs. 151 (99.3%) patients (p=0.99); 30-day MACE-TAVI occurred in 21 (13.9%) vs. 26 (17.1%) patients (p=0.44); fluoroscopy time was lower in the LV-stimulation group (13.48±5.98 vs. 14.60±5.59, p=0.02) as was cost (18,807±1,318 vs. 19,437±2,318, p=0.001).

 

CONCLUSIONS -  Compared with RV-stimulation, LV-stimulation during TAVI was associated with significantly reduced procedure duration, fluoroscopy time, and cost, with similar efficacy and safety.