Prophylactic Temporary Pacing During Percutaneous Coronary Intervention: Indications, Strategies, and Clinical Implications

Prophylactic temporary pacing is a critical consideration during percutaneous coronary intervention (PCI), particularly in scenarios where bradyarrhythmias or atrioventricular block are likely to complicate the procedure. This review examines the risk factors necessitating temporary pacing, evaluates different pacing techniques, and provides an overview of the associated clinical outcomes. We delve into specific interventions like rotational atherectomy and rheolytic thrombectomy, discussing their potential to induce transient cardiac rhythm disturbances and highlighting strategies to mitigate these risks. Evidence suggests diverse scenarios where prophylactic pacing may be beneficial, including coronary atherectomy and procedures involving severe coronary calcification. The efficacy of alternative pacing methods, such as transcoronary unipolar pacing and the use of specialized coronary guidewires, is also explored. This review underscores the importance of personalized pacing strategies tailored to patient-specific and procedural risk factors to optimize clinical outcomes during PCI.