TY - JOUR JO - EuroIntervention TI - Incidence of “Shocktopics” and asynchronous cardiac pacing in patients undergoing coronary intravascular lithotripsy AB - <p><strong>Aims:</strong> Coronary intravascular lithotripsy (IVL) is a novel approach to vascular calcium modification that restores vessel compliance allowing effective lesion expansion. In this study we report the capacity for coronary IVL to precipitate ventricular ectopics (&ldquo;shocktopics&rdquo;) and asynchronous cardiac pacing.</p> <p><strong>Methods and results:</strong> This was a retrospective review of all cases of coronary IVL (n=54) undertaken in the Royal Victoria Hospital, Belfast, between September 2018 and March 2019. The indication for PCI was chronic stable angina in 46.1% (n=26), non-ST-elevation acute coronary syndrome (NSTEACS) in 33.3% (n=18) and ST-elevation myocardial infarction (STEMI) in 18.5% (n=10) of patients. The incidence of coronary IVL-provoked ventricular capture was 77.8% (n=42). Multivariable logistic regression analysis identified heart rate as the only independent predictor of an increased risk of IVL-induced ventricular capture. Patients with a heart rate &lt;65 bpm prior to IVL were sixteen-fold more likely (OR 16.3 [2.4-110.8], p=0.004) to experience events compared to patients with a heart rate &ge;65 bpm. &ldquo;Shocktopic&rdquo; beat morphology was largely uniform in each patient and appeared dependent on the target lesion location, in keeping with mechano-electric coupling through activation of local stretch-activated cardiomyocyte channels. No adverse clinical events occurred as a result of coronary IVL-induced capture.</p> <p><strong>Conclusions:</strong> Coronary IVL with the Shockwave Medical system is associated with a high incidence of &ldquo;shocktopics&rdquo; and asynchronous cardiac pacing that is largely dependent on the resting heart rate. There have been no clinical events associated with this phenomenon, but further systematic evaluation is warranted.</p> AU - Wilson J. Simon AU - Spratt C. James AU - Hill M. Jonathan AU - Spence S. Mark AU - Cosgrove S. Claudia AU - Jones Jeni AU - Strange W. Julian AU - Halperin Henry AU - Walsh J. Simon AU - Hanratty G. Colm VL - 15 IS - 16 Y1 - 20/03/2020 Y1 - 2020 DOI - 10.4244/EIJ-D-19-00484 SP - 1429 EP - 1435 KW - other technique KW - calcified stenosis KW - undilatable lesion PB - Europa Digital & Publishing SE - Coronary interventions UR - https://eurointervention.pcronline.com/article/coronary-intravascular-lithotripsy-is-associated-with-a-high-incidence-of-shocktopics-and-asynchronous-cardiac-pacing SN - 1774-024X ER -