Introduction: In transcatheter aortic valve implantation (TAVI) rapid pacing is an essential step to facilitate precise device placement by reducing cardiac motion. Most commonly, a transvenous pacing device via the internal jugular vein is used, though feasibility of pacing via the guide wire has been demonstrated (wire pacing). In this study we prospectively applied wire pacing in more than 300 consecutive TAVI patients in order to describe procedural outcomes and to identify risk factors for insufficient wire pacing.

Methods: The study cohort consisted of 307 consecutive patients undergoing TAVI at the tertiary center of Ulm University Hospital in 2022. A wire pacing approach was used in all patients. The primary endpoint was defined as insufficient pacing (composite of primary exit block, extrasystole while pacing/insecure capture and insufficient rescue pacing in case of atrioventricular block). Secondary outcome measures were device success, need for permanent pacemaker implantation and procedure related adverse events according to the current VARC criteria.

Results: Mean age was 80.9± 6,5 years, n=169 (55%) were men. Mean body mass index was 26.6± 4.4 kg/m², mean EuroScore II was 6.1±6.0, mean STS score was 4.1± 2.9. A history of coronary artery disease was present in 67.1% (n=206). Previous cardiac surgery was found in 17.3% (n=11.4%), diabetes mellitus was present in 32.9% (n=101). Forty-one percent of subjects had atrial fibrillation (n=126%), left and right bundle branch blocks were present in 8.1% (n=25) and 11.1% (n=34), respectively. An Edwards Sapiens S3® was used in n=162 patients (52.3%), while n=145 patients (47.7%) received a Medtronic Evolut Pro +® bioprosthesis. Sufficient wire pacing was observed in n=288 cases (93,8%). Insufficient pacing in the remaining 19 cases (6.2%) was characterized as exit block in 78.9% (n=15), extrasystole while pacing/insecure capture in 15.8% (n=3), and insufficient rescue pacing in one case (5,3%), respectively. Rescue pacing due to periprocedural AV conduction disturbances was necessary in n=16 cases (5,2% of entire cohort) which was successful in 93.8% (n=15). Reduced left-ventricular ejection fraction (LVEF) was the only parameter with significant correlation to insufficient pacing (univariate logistic regression, p=0.036). The receiver operating characteristic (ROC) curve revealed an optimal cut-off of 52% (sensitivity 63.2%, specificity 63.8%, J= 0.27, AUC 0.632 p= 0.045).

Conclusion: Wire pacing is a feasible and safe pacing alternative for most TAVI patients that does not compromise the safe escalation to a transvenous pacemaker, if necessary. Nonetheless, it is advised to be cautious in patients with reduced LVEF.