Feasibility of ultrasound-guided vascular access during cardiac implantable device placement

Abstract

Purpose: Ultrasound (US)-guided access for venous catheter placement has previously been shown to improve success rates and decrease access-related complications. The purpose of this study was to determine the feasibility of US-guided versus traditional vascular access approaches during implantation of cardiac implantable electronic devices (CIEDs).

Methods: We evaluated outcomes for 816 consecutive patients undergoing new CIED implantation between May 2013 and April 2016 at a single institution with respect to use of US guidance for vascular access (137 with US guidance versus 679 with traditional access techniques). The primary outcome was a composite of procedural complications including deep vein thrombosis, pneumothorax, or hematoma.

Results: There was no cross-over between US guidance and traditional access. The overall complication rate was 3.6% (2.2% in US, 3.8% in non-US). The use of US was associated with a decrease in fluoroscopy time (r = -0.17, p < 0.01) but not the primary outcome (r = 0.03, p = 0.34). In models adjusted for age and number of leads, use of US was non-significantly associated with a change in fluoroscopy time (beta = -0.20, p = 0.7). In logistic models adjusted for age and number of leads, use of US was associated with a trend toward reduced major complications (OR = 0.57, 95% CI 0.17-1.91, p = 0.36).

Conclusions: US-guided vascular access for CIED implantation is safe and effective compared to traditional approaches with a non-significant reduction in both fluoroscopy time and procedural complications.

Keywords: Cardiac resynchronization therapy; Implantable cardioverter-defibrillator; Implantation; Pacemaker; Ultrasound.