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

Table 1 Study and patient characteristics

PMID	Ref. (year of Publication)	Country	Study type	Study period	Patient sample	Male:female	Patient age(years)	Age groups			Weight(kg)	Length(cm)	Cardiac pathology	Past cardiac intervention history
								Neonates	Infants	Children				BAV	SAV
20826965	Gupta et al[9] (2010)	India	Retrospective case series	June 2006-August 2009	A: 5 B: 5	A: 5:0 B: 4:1	A: 5.04 B: 5.04	0	0	10	A: 20.04 B: 14.04	NR	AS NYHA II & III	0	0
20465717	Mehta et al[8] (2010)	United Kingdom	Retrospective case series	NR	25	NR	11.61,4 (1.0 mo-32.0)5	NR	NR	NR	38.81,4 (4.4-67.1)5	NR	Isolated AS: 18/25 (72%)	7/25 (28%)2
													Mixed aortic valve disease: 3/25 (12%)
													Other associated lesions: 4/25 (16%)
16889846	David et al[7] (2007)	Mexico	Non-randomized, prospective	September 2004-July 2005	10	6: 4	10.04 (3.0-16.0)5	0	0	10	NR	NR	Untreated AS with gradient ≥ 50 mm Hg or less, with obstructive and AR grades I– II or without insufficiency.	0	0
15310698	Daehnert et al[6] (2004)	Germany	Prospective pilot	September 2001-August 2003	14	9: 5	13.44 (0.3-20.2)5	0	1	13	48.54 (7.0-79.0)5	158.04 (65.0-180.0)5	AS: 14/14 (100%)	1 (7.6%)	2/14 (14.3%)
N/A3	Ing et al[5] (2002)	United States	Retrospective case series	September 1999-June 2001	13	NR	9.96	NR	NR	NR	31.7 6	NR	AS: 13/13 (100%)	0	0

¹David et al[7] reported on 25 patients who underwent balloon aortic valvuloplasty and 4 patients who had stenting of coarctation (these demographics were not grouped according to type of cardiac pathology).

²Seven patients had previous interventions either in the form of surgery of catheterization.

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.

⁴Median.

⁵Range.

⁶Mean. A: Rapid right ventricular pacing (RRVP); B: RRVP + controlled transient respiratory arrest. PMID: PubMed identification number; BAV: Balloon aortic valvuloplasty; SAV: Surgical aortic valvotomy; AS: Congenital aortic valve stenosis; AR: Aortic regurgitation; CTRA: Controlled transient respiratory arrest; NYHA: New York Heart Association.

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.