Temporary pacing: an overview

2021 ◽  
Vol 16 (9) ◽  
pp. 1-8
Author(s):  
Helen Eftekhari
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
High Risk ◽  
Aortic Valve ◽  
Conduction System ◽  
Temporary Pacing ◽  
Transcatheter Aortic Valve ◽  
Permanent Pacing ◽  
Clinical Presentations ◽  
Patient Groups

This article will review pacing in the context of acute care, with a focus on temporary pacing. Beginning with an overview of the heart's intrinsic electrical conduction system and its function, the discussion moves on to pacing, acute clinical presentations and indications for pacing. This includes an overview of temporary pacing, with the different approaches being percussion, transcutaneous, transvenous and epicardial. There are specific cardiac patient groups at high risk of developing bradyarrhythmias and, in the absence of other measures, potentially requiring emergency pacing. These groups include patients who have experienced a myocardial infarction following cardiac surgery and post transcatheter aortic valve implant. Nurses providing care for patients with temporary transvenous wires need an understanding of the potential complications and to recognise indications for moving on to a permanent pacing system.

scholarly journals Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-5
Author(s):  
Mario Verdugo-Marchese ◽  
Pierre Monney ◽  
Olivier Muller ◽  
Matthias Kirsch
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
High Risk ◽  
Aortic Valve ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is the procedure of choice for aortic stenosis in high surgical risk patients, but it is no free from complications. Case summary A 86-year-old patient with severe aortic stenosis underwent TAVI 3 years ago with an Edwards Sapiens valve by femoral access. In the echocardiography follow-up, an aorta–right ventricular (Ao-RV) fistula was noted with restrictive flow and no significant shunt and it was treated conservatively. Three years after TAVI, the patient underwent cardiac surgery because of worsening heart failure due to a severe degenerative mitral regurgitation with tethering of P2 due to left ventricular remodelling, a posterior jet of severe regurgitation, and left ventricular dilatation. Surgical replacement of the TAVI and aortic root with a bioprosthesis (Medtronic Freestyle) and direct closure of the fistula was performed along with the mitral valve replacement. The patient was discharged with a good clinical result and no evidence of remaining Ao-RV fistula at transthoracic echocardiography. Discussion Aorta–right ventricular fistula is a rare entity. Most reported cases arise after rupture of a congenital coronary sinus aneurism, endocarditis, trauma, and aortic valve or aortic root surgery. This is the 10th reported case after TAVI (9 after an Edwards Sapiens TAVI). Non-significant shunt can be treated conservatively but development of heart failure and death are described in significant shunts. Balloon post-dilatation and the absence of surgical calcium debridement inherent to TAVI may theoretically contribute to the development of the fistula. Surgical replacement and closure of the fistula is a therapeutic option for this entity even in high-risk patients.

scholarly journals Use of extracorporeal membrane oxygenation as a bridge to transcatheter aortic valve replacement in a patient with aortic stenosis and severe coronary artery disease: a case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Majid Ahsan ◽  
Rolf Alexander Jánosi ◽  
Tienush Rassaf ◽  
Alexander Lind
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Artery Disease

Abstract Background Patients with severe aortic stenosis (AS) often present with multiple comorbidities and suffer from critical coronary artery disease (CAD). Transcatheter aortic valve replacement (TAVR) has become the therapy of choice for moderate to high-risk patients. Venoarterial extracorporeal membrane oxygenation (v-a-ECMO) offers the possibility of temporary cardiac support to manage life-threatening critical situations. Case summary Here, we describe the management of a patient with severe AS and CAD with impaired left ventricular ejection fraction (LVEF). We used v-a-ECMO as an emergency strategy in cardiogenic shock during a high-risk coronary intervention to stabilize the patient, and as a further bridge to TAVR. Discussion Very high-risk patients with severe AS are unlikely to tolerate the added risk of surgical aortic valve replacement. Using ECMO may help them to benefit from TAVR as the only treatment option available.

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