Rapid ventricular pacing is necessary during the transcatheter aortic valve implantation performed with a left or a right ventricular stimulation.

To determine the efficacy and the safety of the left direct ventricular pacing during transcatheter aortic valve implantation. Study of the predictive factors of utilization of a standard right ventricular stimulation. Adverse effects of the TAVI before the hospital discharge: descriptive analysis.

This is a retrospective, single-center trial. All patients who underwent transcatheter aortic valve implantation at the Centre Hospitalier Universitaire Gabriel-Montpied (Clermont-Ferrand) were included. Assessment of the efficacy of direct left ventricular pacing. Study of predictive factors of utilization of a standard right ventricular stimulation. Evaluation of procedure complications that occurred during the hospitalization.

Between June 2020 and December 2022, 1001 procedures have been realized and included in our trial. The left ventricular pacing has been effective in 99.8%. We note 2 failures with patients suffering a severe left ventricular dysfunction with medical history of myocardial anterior necrosis. A rescue with right ventricular (RV) stimulation has been used for 90 patients. The intrinsic characteristics of patients didn’t have significant statistical impact on the utilization of RV stimulation. Different arterial approaches (P=0.78), valve model (P=0.238) and size of the valve (P=0.674) also. The presence of a right bundle branch block is significantly associated with a more frequent use of right ventricular stimulation in rescue (31.2%, P<0.0001). The pacemaker implantation rate before discharge concerned 222 patients (24.5%).

Left ventricular direct pacing could become the reference for transcatheter aortic valve implantation procedure. The systematic use of a right ventricular stimulation for patients with a right bundle branch block should be considered. Pacemaker implantation remains the main adverse effect in patients undergoing TAVI.