Cardiac pacing in balloon aortic valvuloplasty.

Objective: To evaluate the rapid ventricular pacing in balloon aortic valvuloplasty to achieve balloon stability.

Material And Methods: From September 2004 to July 2005, a prospective protocol was carried out: ten patients with aortic valve stenosis were treated with this method. Patient's age ranged from 3 to 16 years with mean age of 10.2+/-4.3 years. In all cases a bipolar pacing catheter was placed in the right ventricle. Rapid ventricular pacing was initiated at the rate of 150 per minute and was gradually increased to achieve a 50% drop in systemic pressure. The balloon was inflated only after the pacing rate was reached and the blood pressure dropped. Pacing was continued until the balloon was completely deflated.

Results: The systolic gradients across the aortic valve before balloon dilatation ranged from 40 to 110 mm Hg, mean 68.5+/-20 mm Hg. The pacing rate required to drop the pressure by 50% ranged from 170 to 250 per minute, mean 209+/-25. Balloon stability at time of inflation was achieved in all cases with no balloon movement. The post ballooning gradients ranged from 5 to 28 mm Hg, mean 19.7+/-8.3 mm Hg (p<0.001). In all cases there was no change in aortograms, performed before and after balloon dilatation in aorta, except in one patient who developed grade I aortic regurgitation.

Conclusions: Rapid ventricular pacing appears to be an effective and a safe procedure to stabilize the balloon during balloon aortic valvuloplasty and is thought to decrease the incidence of aortic insufficiency.