A high dose of adenosine to induce transient asystole for valvuloplasty in patients undergoing transcatheter aortic valve implantation (TAVI): Is it a valid alternative to rapid pacing a prospective pilot study

Giedrius Davidavicius, Alaide Chieffo, Joanne Shannon, Francesco Arioli, Alfonso Ielasi, Marco Mussardo, Kensuke Takagi, Francesco Maisano, Mateo Montorfano, Cosmo Godino, Azeem Latib, Antonio Colombo

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Abstract

BACKGROUND: Rapid right ventricular pacing (RRVP) at rates above 200 beats/minute is used to suppress cardiac output during balloon aortic valvuloplasty (BAV) in transcatheter aortic valve replacement (TAVI) patients. A risk of inducing myocardial ischemia with RRVP remains, especially in patients with left ventricular dysfunction. Alternatively, a transient cardiac arrest can be achieved with administration of adenosine. METHODS: The primary endpoint was successful valvuloplasty defined by complete balloon inflation and deflation across aortic valve during the transient asystole induced by adenosine. Secondary endpoints were defined as the failure of adenosine to induce asystole, the incidence of ventricular ectopic beats (VEB) during balloon inflation or deflation, and balloon displacement. RESULTS: From November 2010 to January 2011, twenty consecutive patients who underwent TAVI were included. A balloon for valvuloplasty was positioned across the aortic valve. A low-dose (24 mg, n ≤ 10) or high-dose (36 mg, n ≤ 10) bolus of adenosine was administrated. A single bolus of adenosine-induced atrioventricular (AV) block (mean duration, 18.6 ± 6.6 seconds) followed by cardiac asystole in 16 patients (80%) (low-dose, n ≤ 9). A successful BAV was achieved in 12 patients (60%) (low-dose, n ≤ 8). Adenosine induced only bradycardia in 4 patients (20%) (low-dose, n ≤ 1). A burst of VEB during BAV occurred in all patients. Balloon displacement occurred in 6 patients (37.5%). CONCLUSION: BAV after administration of adenosine is feasible, safe, and may represent an option for high-risk TAVI patients in whom RRVP might not be well tolerated. The occurrence of ventricular ectopic contractions triggered by balloon inflation and deflations accounts for balloon displacement and crossover to RRVP.

Original languageEnglish
Pages (from-to)467-471
Number of pages5
JournalJournal of Invasive Cardiology
Volume23
Issue number11
Publication statusPublished - Nov 2011

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Heart Arrest
Adenosine
Balloon Valvuloplasty
Prospective Studies
Economic Inflation
Ventricular Premature Complexes
Aortic Valve
Transcatheter Aortic Valve Replacement
Atrioventricular Block
Left Ventricular Dysfunction
Bradycardia
Cardiac Output
Myocardial Ischemia
Incidence

Keywords

  • adenosine
  • TAVI
  • valvuloplasty

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

A high dose of adenosine to induce transient asystole for valvuloplasty in patients undergoing transcatheter aortic valve implantation (TAVI) : Is it a valid alternative to rapid pacing a prospective pilot study. / Davidavicius, Giedrius; Chieffo, Alaide; Shannon, Joanne; Arioli, Francesco; Ielasi, Alfonso; Mussardo, Marco; Takagi, Kensuke; Maisano, Francesco; Montorfano, Mateo; Godino, Cosmo; Latib, Azeem; Colombo, Antonio.

In: Journal of Invasive Cardiology, Vol. 23, No. 11, 11.2011, p. 467-471.

Research output: Contribution to journalArticle

Davidavicius, Giedrius ; Chieffo, Alaide ; Shannon, Joanne ; Arioli, Francesco ; Ielasi, Alfonso ; Mussardo, Marco ; Takagi, Kensuke ; Maisano, Francesco ; Montorfano, Mateo ; Godino, Cosmo ; Latib, Azeem ; Colombo, Antonio. / A high dose of adenosine to induce transient asystole for valvuloplasty in patients undergoing transcatheter aortic valve implantation (TAVI) : Is it a valid alternative to rapid pacing a prospective pilot study. In: Journal of Invasive Cardiology. 2011 ; Vol. 23, No. 11. pp. 467-471.
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abstract = "BACKGROUND: Rapid right ventricular pacing (RRVP) at rates above 200 beats/minute is used to suppress cardiac output during balloon aortic valvuloplasty (BAV) in transcatheter aortic valve replacement (TAVI) patients. A risk of inducing myocardial ischemia with RRVP remains, especially in patients with left ventricular dysfunction. Alternatively, a transient cardiac arrest can be achieved with administration of adenosine. METHODS: The primary endpoint was successful valvuloplasty defined by complete balloon inflation and deflation across aortic valve during the transient asystole induced by adenosine. Secondary endpoints were defined as the failure of adenosine to induce asystole, the incidence of ventricular ectopic beats (VEB) during balloon inflation or deflation, and balloon displacement. RESULTS: From November 2010 to January 2011, twenty consecutive patients who underwent TAVI were included. A balloon for valvuloplasty was positioned across the aortic valve. A low-dose (24 mg, n ≤ 10) or high-dose (36 mg, n ≤ 10) bolus of adenosine was administrated. A single bolus of adenosine-induced atrioventricular (AV) block (mean duration, 18.6 ± 6.6 seconds) followed by cardiac asystole in 16 patients (80{\%}) (low-dose, n ≤ 9). A successful BAV was achieved in 12 patients (60{\%}) (low-dose, n ≤ 8). Adenosine induced only bradycardia in 4 patients (20{\%}) (low-dose, n ≤ 1). A burst of VEB during BAV occurred in all patients. Balloon displacement occurred in 6 patients (37.5{\%}). CONCLUSION: BAV after administration of adenosine is feasible, safe, and may represent an option for high-risk TAVI patients in whom RRVP might not be well tolerated. The occurrence of ventricular ectopic contractions triggered by balloon inflation and deflations accounts for balloon displacement and crossover to RRVP.",
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AU - Davidavicius, Giedrius

AU - Chieffo, Alaide

AU - Shannon, Joanne

AU - Arioli, Francesco

AU - Ielasi, Alfonso

AU - Mussardo, Marco

AU - Takagi, Kensuke

AU - Maisano, Francesco

AU - Montorfano, Mateo

AU - Godino, Cosmo

AU - Latib, Azeem

AU - Colombo, Antonio

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N2 - BACKGROUND: Rapid right ventricular pacing (RRVP) at rates above 200 beats/minute is used to suppress cardiac output during balloon aortic valvuloplasty (BAV) in transcatheter aortic valve replacement (TAVI) patients. A risk of inducing myocardial ischemia with RRVP remains, especially in patients with left ventricular dysfunction. Alternatively, a transient cardiac arrest can be achieved with administration of adenosine. METHODS: The primary endpoint was successful valvuloplasty defined by complete balloon inflation and deflation across aortic valve during the transient asystole induced by adenosine. Secondary endpoints were defined as the failure of adenosine to induce asystole, the incidence of ventricular ectopic beats (VEB) during balloon inflation or deflation, and balloon displacement. RESULTS: From November 2010 to January 2011, twenty consecutive patients who underwent TAVI were included. A balloon for valvuloplasty was positioned across the aortic valve. A low-dose (24 mg, n ≤ 10) or high-dose (36 mg, n ≤ 10) bolus of adenosine was administrated. A single bolus of adenosine-induced atrioventricular (AV) block (mean duration, 18.6 ± 6.6 seconds) followed by cardiac asystole in 16 patients (80%) (low-dose, n ≤ 9). A successful BAV was achieved in 12 patients (60%) (low-dose, n ≤ 8). Adenosine induced only bradycardia in 4 patients (20%) (low-dose, n ≤ 1). A burst of VEB during BAV occurred in all patients. Balloon displacement occurred in 6 patients (37.5%). CONCLUSION: BAV after administration of adenosine is feasible, safe, and may represent an option for high-risk TAVI patients in whom RRVP might not be well tolerated. The occurrence of ventricular ectopic contractions triggered by balloon inflation and deflations accounts for balloon displacement and crossover to RRVP.

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