Safety of Percutaneous Right Coronary Intervention without Temporary Pacemaker: Prospective Study

Abstract

BackgroundThe prophylactic use of temporary pacemaker during coronary intervention has been markedly decreased since 1980's. There is, however, few systematic report focusing on right coronary intervention in which temporary pacemaker would be most beneficial. Moreover, there has been marked development in coronary intervention recent years that risk and benefit of prophylactic pacemaker should be reconsidered. Method We performed right coronary artery intervention without prophylactic use of temporary pacemaker in 100 successive patients in Samsung Medical Center. Patients with previous AV block and rotational atherectomy cases were excluded. The incidence of all complications and changes of blood pressure as well as heart rate during coronary intervention were examined prospectively. Results The lesion type was B2 or C in 52% and intracoronary thrombus was found in 18% of patients. Nevertheless, there was neither life threatening bradycardia nor new onset arrhythmia in any patient during right coronary intervention. Conclusion These data suggest that omission of prophylactic use of temporary pacemaker may be safe in right coronary intervention only if excluding previous patients with high degree atrioventricular block and rotational atherectomy cases. This approach may reduce procedure time and cost as well as pacemaker-associated complications.

Feasibility and safety of the transradial approach for the intracoronary spasm provocation test

“…Palomo et al [33] also reported the increased risk of ventricular and supraventricular arrhythmia associated with prophylactic pacing during coronary angiography and suggested that routine prophylactic pacemaker insertion during coronary angiography is not warranted in patients with normal sinus rhythms and normal atrioventricular conduction. Lee et al [34] reported that the omission of prophylactic use of temporary pacemaker might be safe in right coronary intervention only when excluding patients with a previous high degree of atrioventricular block or with rotational atherectomy. Thus, a spasm provocation test without the use of a temporary pacemaker may have an advantage for reducing such complications.…”