Rapid ventricular pacing is intentionally used during certain structural heart procedures to temporarily increase the ventricular rate, producing a controlled reduction in cardiac output, stroke volume, pulse pressure, and systolic blood pressure. This brief period of low cardiac output minimizes cardiac motion and blood flow across the aortic valve, helping stabilize the balloon or transcatheter valve during deployment and reducing the risk of valve displacement or embolization.

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This educational program provides an overview of rapid ventricular pacing (RVP) during transcatheter aortic valve replacement (TAVR), with an emphasis on its purpose, procedural technique, safety considerations, and relationship to conduction disturbances. The education begins with a review of the cardiac conduction system and its close anatomical relationship to the aortic valve and left ventricular outflow tract. The resource reviews the use of a temporary right ventricular pacing wire, including testing ventricular capture and confirming an adequate safety margin before valve deployment. Post-deployment assessment includes evaluation of valve position, coronary flow, transvalvular gradients, paravalvular regurgitation, pericardial effusion, and new conduction abnormalities. The temporary pacing wire may remain in place for backup pacing when new conduction abnormalities are present, including bundle-branch block, PR/QRS prolongation, or high-grade/complete heart block. Potential risks of RVP are also addressed, along with the factors associated with an increased risk of TAVR-related conduction disturbances.