Direct Wire Pacing for Challenging Left Main Stenting: An Old Technique Revived

J INVASIVE CARDIOL 2021;33(12):E1010.

Key words: percutaneous coronary intervention, rapid pacing

A 71-year-old woman was admitted to our institution. A coronary angiogram showed multivessel disease including a severe stenosis of the left main coronary artery (LMCA) bifurcation involving the left anterior descending artery (LAD) ostium (Medina 1,1,0). A staged LMCA and LAD percutaneous coronary intervention (PCI) was performed using radial approach (Figure 1 and Video Series). Due to the absence of lesion and the small caliber of the circumflex artery, only 1 guidewire was advanced in the distal part of the LAD. After predilation with a non-compliant balloon, during stent positioning, we observed a major motion of our device in the LMCA. Under those conditions and considering our strategy to not miss this mid-LMCA stenosis and cover the ostium, an accurate stent placement was uncertain despite optimal angiographic view (left anterior oblique 45°-cranial 25°). To figure out this situation, we decided to perform a rapid direct wire pacing. Using 2 alligator clamps, the cathode was clipped to the back end of the LAD guidewire while the anode was clipped to a subcutaneous needle in the anesthetized wrist skin. The external cardiac pacemaker provided a 180 beats/min stimulation at 10 mA power (pulse width, 1.5 ms). We obtained a 1-for-1 capture for 15 seconds that led to a cardiac standstill, allowing accurate stent deployment (34 x 4 mm Ultimaster Tansei Bx; Terumo Corporation) with a good final angiographic result.

From the Cardiovascular Institute of Grenoble, Groupe Hospitalier Mutualiste, Grenoble, France.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted July 16, 2021.

The authors report patient consent for the images used herein.

Address for correspondence: Benjamin Faurie, MD, Cardiovascular Institute, Groupe Hospitalier Mutualiste, 8 Rue Dr Calmette, 38000 Grenoble, France. Email: faurieb@gmail.com

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