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Rapid ventricular pacing versus adenosine
administration for reduction of systemic
arterial pressure during aortic valve baloon
angioplasty
Nikolas Kipshidze, Tamaz Shaburishvili,
George Khabeishvili, Maia Abdushelishvili.
Academician N.Kipshidze’s Central University
Hospital, Tbilisi, Georgia
Open heart surgery for patients who needs
valvular replacement is standard approach.
Many patients with a single diseased valve
were declined for surgery because of
advanced age, end-stage disease and
comorbidities with short life expectancy. In
such patients percutaneous transfemoral
aortic valve implantation has been
proposed as an alternative traetment.
The aim of this work was to study pacing
versus adenosine administration for
reduction in systemic arterial pressure
during ballon placement for aortic valve
dilatation.
12-24 mg rapid intravenous Adenosine infusion caused
transient (10-15 sec) high degree atrioventricular (AV)
block. This is enough time for rapid baloon inflation
and deflation at the level of the aortic valve determined
by fluoroscopy and transesophageal echocardiography.
55 patients were studied.
To achive adequate reduction in arterial
pressure during baloon inflation and deflation
rapid ventricular pacing was used. As above
mentioned, patients with advanced age, endstage disease and comorbidities are usualy
selected for percutaneous heart valve
implantation. This cohort is expected to
increase complications during rapid ventricular
pacing, such as ventricular rhythm
disturbances. Suggested method to stop heart
beat using adenosin infusion was safe (no
serious complication were observed) and
effective ( ability to produce transitory high
degree atrioventricular block was 100%).
To minimize transaortic flow and cardiac motion
rapid ventricular pacing is used
Rapid ventricular pacing-1:1 capture-hypotension.
Cessation of pacing is associated with rapid
normalization of arterial pressure.
Rapid intravenous administration of adenosine
can provoke high degree AV-block. Continues
echocardiographic registration of aortic valve.
35 sec asystolic epizode was observed after 4 ml
adenosine infusion.
Conclusion:
Rapid intravenous administration of
adenosine is a best way for reduction
of arteril blood pressure.
It successfully substituted rapid
ventricular pacing used during ballon
angioplasty for achiving adequate
reduction in systemic arterial
pressure.