Ultrasound-guided Versus Fluoroscopy-guided Axillary Vein Puncture for Cardiac Implantable Electronic Device Implantation: a Meta-analysis Enrolling 1257 Patients

Overview

Journal J Interv Card Electrophysiol

Publisher Springer

Date 2024 Oct 24

PMID 39448460

Authors

Giampaolo Vetta

Antonio Parlavecchio

Jennifer Wright

Michele Magnocavallo

Lorenzo Marcon

Ioannis Doundoulakis

Roberto Scacciavillani

Antonio Sorgente

Luigi Pannone

Alexandre Almorad

Juan Sieira

Charles Audiat

Kazutaka Nakasone

Gezim Bala

Erwin Stroker

Ingrid Overeinder

Pietro Rossi

Andrea Sarkozy

Gian-Battista Chierchia

Carlo de Asmundis

Domenico Giovanni Della Rocca

Affiliations

Soon will be listed here.

Abstract

Introduction: Ultrasound-guided (Echo-AVP) and Fluoroscopy-guided Axillary Vein Puncture (Fluoro-AVP) are both acknowledged as safe and effective techniques for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of Echo-AVP versus Fluoro-AVP for CIEDs implantation.

Methods: We systematically searched Medline, Embase and Cochrane electronic databases up to May 15th, 2024, for studies that evaluated the efficacy and safety of Echo-AVP and Fluoro-AVP reporting at least one clinical outcome of interest. The primary efficacy endpoint was acute procedural success and the primary safety endpoint was a composite endpoint of pneumothorax, pocket hematoma/bleeding, pocket infection and inadvertent arterial puncture. The effect size was estimated using a random-effect model as Odds Ratio (OR) and Mean Difference (MD) with relative 95% Confidence Interval (CI).

Results: Overall, 4 studies were included, which enrolled 1257 patients (Echo-AVP: 373 patients; Fluoro-AVP: 884 patients). Echo-AVP led to a significant reduction in the primary safety endpoint (OR: 0.41; p = 0.0009), risk of inadvertent arterial puncture (OR: 0.29; p = 0.003) and fluoroscopy time ( MD: -105.02; p = 0.008). No differences were found between Echo-AVP and Fluoro-AVP for acute procedural success (OR: 0.77; p = 0.27), pneumothorax (OR: 0.66; p = 0.60), pocket hematoma/bleeding (OR: 0.68; p = 0.30), pocket infection (OR: 0.66; p = 0.60), procedural time (MD: 1.99; p = 0.65), success rate at first attempt (OR: 1.25; p = 0.34) and venous access time (MD: -0. 25; p = 0.99).

Conclusion: Echo-AVP proved to reduce significantly the primary safety endpoint, inadvertent arterial puncture and fluoroscopy time compared to Fluoro-AVP.

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