Device console programming in patients undergoing TAVI with preexisting cardiac implantable electronic devices: a practical guide

Transcatheter aortic valve implantation (TAVI) is established as the standard of care for patients across all surgical risk profiles, with expanding indications in younger and lower-risk populations. A substantial proportion of patients eligible for TAVI have preexisting cardiac implantable electronic devices (CIED). Temporary transvenous right ventricular (RV) pacing is routinely used during TAVI to facilitate procedural safety but carries inherent risks, including RV perforation, cardiac tamponade, and lead dislodgement. Alternative pacing strategies, such as left ventricular pacing via the valve delivery guidewire, have been proposed to reduce procedural complications. In patients with a preexisting CIED, leveraging the implanted device for procedural pacing represents a rational and potentially safer option. However, its adoption remains limited, largely due to unfamiliarity with device-specific programming. This article provides a detailed, step-by-step practical guide for programming rapid ventricular pacing using the most widely encountered CIED platforms: Biotronik, Medtronic, Abbott/St. Jude, Sorin, and Boston Scientific. The specific programming pathways for each manufacturer are summarized to facilitate safe, effective, and reproducible implementation during TAVI.