Rotational Atherectomy and Simultaneous Temporary Transvenous Pacing Through a Forearm Approach

J INVASIVE CARDIOL 2018;30(4):E31-E32.

Key words: right heart catheterization, mapping catheter 

Rotational atherectomy (RA) may be associated with the development of heart block and the need for temporary pacing in approximately 50% of procedures performed in the right coronary artery; therefore, prophylactic pacemaker insertion may be considered appropriate.  

Given that RA can be performed with equal effectiveness using radial artery access, thereby minimizing patient discomfort and access-site bleeding complications, a transradial procedure should be preferred, especially for high bleeding risk patients.

Using a femoral access for the temporary pacemaker in these patients negates some of the advantages of a transradial procedure. Indeed, registry data suggest that patients undergoing RA via transradial approach are less likely to receive a temporary transvenous pacemaker compared to patients undergoing RA via transfemoral approach, reflecting perhaps operator reluctance.

Since right heart catheterization can be performed through the forearm in an easier and safer manner, we used this approach to introduce prophylactically a transvenous pacemaker in a high bleeding risk patient undergoing RA in the right coronary artery. According to local protocol, a 7 Fr sheath was introduced in the radial artery, while an antecubital fossa vein of the ipsilateral arm was cannulated with a 6 Fr transradial sheath (Figure 1). A 6 Fr bipolar mapping catheter was then advanced under fluoroscopic guidance into the right ventricle and was used for on-demand pacing during the procedure. After the procedure, hemostasis was achieved with brief manual compression of the venous access site, while a compression device was used on the radial artery. Following an uneventful 8-hour period of observation, the patient was discharged home. To the best of our knowledge, this is the first reported RA procedure with transvenous pacing utilizing a complete forearm approach, which illustrates the feasibility of this procedure and its advantages for the patient.

From the 1st Department of Cardiology, Athens Red Cross Hospital, Athens, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted January 16, 2018. 

Address for correspondence: Theodoros Zografos, MD, MSc, PhD, Consultant Cardiologist, 3rd Department of Cardiology, Hygeia Hospital Research Associate, Athens Red Cross Hospital, 8 Artemidos Street, 16672, Vari, Athens, Greece. Email: theodoroszografos@gmail.com