Arrhythmogenic risk of pulmonary artery catheterisation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Abstract

SummaryMany clinicians consider severe aortic stenosis to be a contraindication to pulmonary artery catheterisation, except during open heart surgery with cardiopulmonary bypass. This is due to the perceived high risk of arrhythmia, although the true incidence of ventricular tachycardia and fibrillation remains unclear. We conducted a retrospective study to estimate the incidence of severe arrhythmias during pulmonary artery catheterisation in 380 patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation. Ventricular fibrillation was seen in only one patient (0.26%), and this was successfully terminated by external defibrillation. No episodes of ventricular tachycardia were recorded and there were also no arrhythmias during removal of the catheter. We have therefore concluded that pulmonary artery catheterisation in patients with severe aortic stenosis is not associated with a high incidence of ventricular fibrillation or tachycardia, allowing pulmonary artery pressure monitoring to be performed relatively safely in such patients.

Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature

“…Severe life-threatening arrhythmias, such as sustained VT and VF can occur during RHC but are very rare[ 19 ]. Wennevold et al[ 3 ] reported that only 2 VT and 2 VF episodes occurred during more than four thousand RHC (< 0.1%) performed from 1947 to 1963 (before the design of balloon tipped Swan-Ganz catheter).…”

“…Wennevold et al[ 3 ] reported that only 2 VT and 2 VF episodes occurred during more than four thousand RHC (< 0.1%) performed from 1947 to 1963 (before the design of balloon tipped Swan-Ganz catheter). The incidence of sustained VT or VF, requiring anti-arrhythmia treatment either by medication or cardioversion, is relatively low (0.26%[ 19 ], 1%[ 20 ], 1.5%[ 21 ] , 4.7%[ 17 , 22 - 28 ]). Bergmann et al[ 19 ] reported that no episodes of VT and 1 episode of VF requiring defibrillation occurred out of 380 RHCs (0.3%) performed for patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.…”

“…The incidence of sustained VT or VF, requiring anti-arrhythmia treatment either by medication or cardioversion, is relatively low (0.26%[ 19 ], 1%[ 20 ], 1.5%[ 21 ] , 4.7%[ 17 , 22 - 28 ]). Bergmann et al[ 19 ] reported that no episodes of VT and 1 episode of VF requiring defibrillation occurred out of 380 RHCs (0.3%) performed for patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. However, Gwak et al[ 13 ] reported a 2% incidence rates for VT or VF episodes requiring either withdrawal of the catheter or defibrillation, in their prospective observation of 100 PA catheter placements in the OR for liver allograft transplant recipients.…”