Safety and Efficacy of Rapid Ventricular Pacing-assisted Embolization of Arteriovenous Malformations and Vein of Galen Malformations: A Systematic Review of Preliminary Evidence
Lucero Brigitte Diaz Capcha1, Manuel Llacsahuache Tomas1, Jhonatan Zumaeta1, Jhon Bocanegra-Becerra1, AHMET GÜNKAN2, Marcio Ferreira3
1School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru, 2Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 3Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
Objective:
To determine the safety and efficacy of rapid ventricular pacing (RVP)-assisted embolization in patients with arteriovenous malformations (AVMs) and vein of Galen malformations (VGMs).
Background:
AVMs and VGMs are high-flow vascular anomalies that can lead to severe morbidity and mortality. Due to their complex hemodynamics, RVP has been proposed as a method to induce controlled hypotension and facilitate embolization by temporarily decreasing the venous shunting, allowing the liquid embolic to lodge in the nidus or fistulous point. However, the safety and efficacy of this technique remain uncertain, underscoring the need for a systematic review to consolidate existing data and guide clinical practice.
Design/Methods:
Following PRISMA guidelines, PubMed, Embase, and Scopus were searched up to September 2024 for original studies describing RVP-assisted embolization of AVMs and VGMs. Safety and efficacy outcomes were evaluated by pooling information on technical protocols, intraoperative complications, and morbidity and mortality attributed to RVP.
Results:
Seven of 2002 articles met the inclusion criteria. The analysis included 27 patients, 27 lesions (17 AVMs and 10 VGMs), and 36 RVP-assisted embolizations. Among embolization approaches, the combined transarterial and transvenous access was predominantly used for AVMs (72.97%), whereas VGMs were almost exclusively treated via the transarterial access (94.44%). Onyx was the most frequently used embolic agent in both groups. Complete occlusion was achieved in 80% of AVMs and 70% of VGMs. Among RVP-related complications, arrhythmias occurred in one AVM case (6.67%) and one VGM case (10%). Mortality occurred in one patient from each group (5.88% AVMs, 10.00% VGMs).
Conclusions:
RVP is an uncommon and logistically complex technique; however, it may offer advantages during the embolization of AVMs and VGMs. Although current evidence is limited, it suggests RVP could be safe and effective, given the high occlusion rates and minimal complications and mortality rates. Nonetheless, further research is required to validate these findings.
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