Rapid right ventricular pacing for balloon valvuloplasty in congenital aortic stenosis: A systematic review

Table 2 Outcomes of rapid right ventricular pacing-assisted balloon aortic valvuloplasty

PMID	Ref. (year of Publication)	Timing of RRVP	Pacing mode	Pacing rate(bpm)	Pacing time (sec)	Balloon length(mm)	Balloon diameter (mm)	Balloon displacement	Pre-BAV PS gradient(mmHg)	Post-BAV PS gradient(mmHg)	Pre-BAVAR	Post-BAVAR			Sustained arrhythmias	Other procedure-related complications
20826965	Gupta et al[9] (2010)	Pacing until SBP dropped by 50%	NR	NR	NR	Balloon:aortic annulus size = 1:1		A: 1/5 (20%) B: 0%	Gradient reduction (%): A: 52.2% B: 70.1%; P = 0.25		G0: 10/10 (100%)		A	B	None	None
												G0	0%	2/5 (40%)
												G1	0%	0%
												G2	4/5 (80%)	3/5 (60%)
												G3	1/5 (20%)	0%
												G4	0%	0%
204657174	Mehta et al[8] (2010)	Initially 180 bpm. Pacing rate was increased by 20 bpm until SBP dropped by 50% ± pulse pressure by 25%	AAI/AO	2405 (200-260)6	NR	NR	NR	1/25 (4%)	Gradient reduction: 205 (0-60)6		G0: 22 (88%)	G0: 16/22 (72.7%)			1/25 (4%) VFib which was successfully cardioverted	None
											G1:0%	G1:0%
											G2:0%	G2: 6/22 (27.8%)
											G3:0%	G3:0%
											G4:0%	G4: 0%
16889846	David et al[7] (2007)	Initially at a frequency slightly higher than the spontaneous patient's frequency. Pacing rate was increased until SBP dropped by 50%	NR	2097 (170-250)6	NR	40 (40-40)	185 (14-22)6	NR	68.57 ± 208	19.77 ± 8.38	G0: 6/10 (60%)	G0: 5/10 (50%)			None	None
											G1: 4/10 (40%)	G1: 5/10 (50%)
											G3: 0%	G3: 0%
											G4: 0%	G4: 0%
15310698	Daehnert et al[6] (2004)	After failure of first non-paced dilatation attempt	VVI	2202	12.77 (7-16)6	605 (30-60)6	205 (10-25)6	3/14 (21.4%)1	82.55 (60-110)6	28.65 (10-50)6	G0: 7/14 (50%)	G0: 1/14 (7.1%)			None	None
											G1: 3/14 (21.4%)	G1: 0
											G2: 4/14 (28.6%)	G2: 11/14 (78.6%)
											G3: 0%	G3: 2/14 (14.3%)
											G4: 0%	G4: 0%
N/A3	Ing et al[5] (2002)	Pacing just prior to balloon inflation. HR increased by an average of 80 ± 29% & LV systolic pressure decreased by 36 ± 12%.	NR	NR	NR	NR	NR	1/13 (20.1%)	67.87 ± 18.68	19.47 ± 9.18	G0: 13/13 (100%)	G0: 10/13 (76.9%)			None	None
												G1: 1/13 (7.7%)
												G2: 2/13 (18.4%)
												G3: 0%
												G4: 0%

¹Two in the aorta and 1 in the left ventricle.

²In 2 patients the balloon continued to move and rapid right ventricular pacing (RRVP) was increased to 240 bpm.

³Ing et al[5] was the first group to describe rapid right ventricular pacing for balloon aortic valvuloplasty in an abstract at the Journal of the American College of Cardiology.

⁴To accurately quantify the impact of RRPV on post-balloon aortic valvuloplasty (BAV) aortic regurgitation (AR) rates, we had to exclude 3 patients since pre-BAV they had “mixed aortic valve disease” of unknown severity.

⁵Median.

⁶Range.

⁷Mean.

⁸Standard deviation. G0: No AR; G1: Grade 1 AR (trivial); G2: Grade 2 AR (mild); G3: Grade 3 AR (moderate); G4: Grade 4 AR (severe); A: RRVP; B: RRVP + controlled transient respiratory arrest; NR: not reported; PMID: PubMed identification number; RRVP: Rapid right ventricular pacing; PS: Peak systolic; AR: Aortic regurgitation; SBP: Aortic systolic blood pressure; VFib: Ventricular fibrillation; CTRA: Controlled transient respiratory arrest.