Transthoracic echo-guided pacemaker implantation reduces fluoroscopic use in dogs

Area of Science:

• Veterinary Cardiology
• Medical Imaging
• Interventional Procedures

Background:

• Fluoroscopy is the standard for guiding pacemaker implantation but involves radiation exposure.
• Echocardiography, including transthoracic (TTE) and transesophageal echocardiography, has emerged as a viable alternative for guiding veterinary interventional procedures.
• Radiation risks and equipment limitations necessitate exploring alternative guidance methods for pacemaker implantation.

Purpose of the Study:

• To evaluate the efficacy of TTE as a primary guidance method for pacemaker lead implantation in dogs.
• To assess if TTE can minimize or replace the use of fluoroscopy during this procedure.
• To determine the feasibility of real-time TTE visualization for accurate lead placement.

Main Methods:

• A prospective case series involving pacemaker implantation guided by TTE in dogs.
• Utilized specific right parasternal echocardiographic views to visualize endocardial lead advancement to the right ventricular apex.
• Confirmed lead placement using capture threshold, impedance, and limited fluoroscopy/radiography.

Main Results:

• Successfully implanted pacemaker leads in the right ventricle of 21 dogs using TTE guidance.
• TTE provided sufficient real-time imaging quality for monitoring and correcting lead malpositioning or looping.
• Fluoroscopy was used minimally, primarily for final confirmation or static imaging of lead redundancy.

Conclusions:

• TTE is a safe and effective alternative method for guiding pacemaker lead implantation in dogs, significantly reducing fluoroscopy use.
• Real-time TTE guidance facilitates accurate lead placement and allows for immediate adjustments.
• Further studies with larger case series are warranted to validate the long-term safety and effectiveness of TTE in this application.