Transapical epicardial temporary pacemaker lead implantation in patients with transapical TAVI.

OBJECTIVE: This study aimed to evaluate the safety and efficacy of transapical epicardial temporary pacemaker lead implantation compared with the conventional transvenous approach in patients undergoing transapical transcatheter aortic valve implantation (TAVI). METHODS: In this single-centre retrospective study, 399 patients who underwent transapical TAVI between December 2018 and August 2024 were included. Of these, 298 received transapical epicardial temporary pacing leads and 101 received transvenous leads. Primary outcomes included pacemaker-related cardiac tamponade, valve displacement and mortality. Secondary outcomes encompassed perioperative complications, permanent pacemaker implantation and postoperative adverse events. RESULTS: No cases of cardiac tamponade, valve displacement or mortality related to temporary pacing were observed in either group. Poor lead contact occurred in one patient (0.3%) in the transapical group versus three patients (3.0%) in the transvenous group (p=0.05). Postoperative permanent pacemaker implantation was required in 12 transapical patients (4.0%) and three transvenous patients (3.0%, p=0.86). CONCLUSION: Transapical epicardial temporary pacing is a safe and effective alternative to transvenous pacing during transapical TAVI, with comparable complication rates and potential technical benefits. Further randomised studies are warranted to validate these findings and explore long-term outcomes.