Transapical epicardial temporary pacing is a safe and effective alternative to transvenous pacing during transapical TAVI, with comparable complication rates and potential technical benefits.
Key Findings
Results
No cases of pacemaker-related cardiac tamponade, valve displacement, or mortality were observed in either the transapical epicardial or transvenous temporary pacing groups.
399 total patients underwent transapical TAVI between December 2018 and August 2024 at a single centre
298 patients received transapical epicardial temporary pacing leads
101 patients received conventional transvenous leads
Primary outcomes of cardiac tamponade, valve displacement, and mortality were zero in both groups
Results
Poor lead contact occurred significantly less frequently in the transapical epicardial group compared with the transvenous group.
Poor lead contact occurred in 1 patient (0.3%) in the transapical group versus 3 patients (3.0%) in the transvenous group
p=0.05
This was a secondary outcome measure encompassing perioperative complications
Results
Postoperative permanent pacemaker implantation rates were similar between the transapical epicardial and transvenous temporary pacing groups.
Permanent pacemaker implantation was required in 12 transapical patients (4.0%) versus 3 transvenous patients (3.0%)
p=0.86, indicating no statistically significant difference between groups
Permanent pacemaker implantation was included as a secondary outcome measure
Methods
This was a single-centre retrospective study comparing two approaches to temporary pacing during transapical TAVI over approximately six years.
Study period ran from December 2018 to August 2024
Single-centre retrospective design
Total cohort of 399 patients, with approximately 74.7% receiving transapical epicardial leads and 25.3% receiving transvenous leads
Authors note that further randomised studies are warranted to validate findings and explore long-term outcomes
What This Means
During a type of minimally invasive heart valve replacement surgery called transapical TAVI (where the new valve is delivered through a small opening at the tip of the heart), surgeons need a way to temporarily pace the heart. Traditionally, this is done by threading a wire through a large vein (transvenous approach). This study examined whether attaching a pacing wire directly to the outer surface of the heart through the same surgical opening used for the procedure (transapical epicardial approach) is a safe and effective alternative. Researchers reviewed records from 399 patients who had the surgery at a single hospital over about six years.
This research suggests that neither approach caused serious pacing-related complications such as fluid around the heart (cardiac tamponade), valve displacement, or death. The transapical epicardial approach showed a notably lower rate of poor electrical contact between the pacing lead and the heart (0.3% vs. 3.0%), though this difference was borderline statistically significant. Rates of needing a permanent pacemaker after surgery were similarly low in both groups (4.0% vs. 3.0%).
This research suggests that placing the temporary pacing wire directly on the heart's surface during transapical TAVI is a viable alternative to the conventional vein-based approach, potentially simplifying the procedure since the pacing lead can be placed through the same access point already being used. However, because this was a retrospective single-centre study, the authors caution that randomised controlled trials are needed to confirm these findings and assess longer-term outcomes.
Liang C, Li M, Feng Z, Zhao P, Xiao Y, Ma R, et al.. (2026). Transapical epicardial temporary pacemaker lead implantation in patients with transapical TAVI.. Open heart. https://doi.org/10.1136/openhrt-2025-003960