An Attempt to Make TAVR Safer

The broad expansion of transcatheter aortic ized the treatment of aortic valve disease, offering a less invasive alternative to traditional open heart surgery. According to registry data, more than 147,000 TAVR procedures were performed in United States in 2022, with roughly a 3-fold increase among patients <65 years of age in recent years.1 The need to embrace a minimalistic approach in TAVR procedures is important to decrease patient risk, to reduce lengths of hospital stay, and to enhance recovery, making transcatheter valve intervention accessible to a wider range of patients.2 In this light, simplification of left ventricular (LV) pacing strategies during TAVR is one aspect to streamline the procedure and to reduce the risk for complications related to right ventricular (RV) lead placement such as pericardial effusion, hematomas, and fistulae secondary to venous cannulation. To overcome limitations secondary to RV pacing, alternative techniques such as pacing over the LV guidewire have been developed to safely perform pacing during predilation, valve deployment, and postdilatation. Pacing over the LV guidewire has been demonstrated to be a safe, reliable option, noninferior to traditional RV pacing in Nevertheless, despite proper setup and materials,