Typically, a right ventricular pacemaker is used during TAVR procedures, but in the past couple years there has been a movement toward left ventricular pacing. This uses the delivery wire for the TAVR valve where the wire is shaved and alligator clips are placed on it so electrical signals can be delivered. This eliminates the need for a separate vascular access site or extra wire placement, simplifying the procedure and increasing patient safety. 

"This has already been adopted in Europe and slowly, but surely, it is make its way into the United States," Genereux explained. "We can use the delivery wire for nondedicated pacing, you just shave the wire and make it happen, but now there are is a dedicated wire for deliver of the valve and pacing in the LV."

One option he is excited about is the novel Savvywire from Opsens, which can both deliver the TAVR valve and has the capacity to serve as a pacing wire and offers live monitoring of the hemodynamics. Genereux said it can show the gradients and the regurgitation indices.

The Telefax Wattson wire is another option for pacing, but he said it does not offer any moderating of the gradient.

The Biotrace Tempo lead is another option, which is a temporary pacing lead with a balloon expanded anchor to seat it securely in the right ventricle. Some patients experience arrhythmia issues following the implant of the valve. This can occur when the valve is expanded and presses on nerves in the septum and causing an irregular heart rhythm, which can require a permanent pacemaker to solve the issue. Genereux said this is a good option for patients with right bundle branch block that require temporary placing for 24-48 hours to buy time in making a decision if the patient requires a permanent pacemaker prior to discharge.

"Most of the patients, I would say about 90% of patients after TAVR, will not need this type of surveillance, but there is a proportion of patients that will need this surveillance," Genereux explained.