Comparative analysis of ultrasound-guided versus fluoroscopy-guided venous puncture techniques for pacemaker...

Ultrasound-guided pacemaker puncture allows for visualization of vascular anatomy in real time, potentially reducing complications; however, detailed comparative studies with the traditional fluoroscopy-guided technique are lacking, particularly those incorporating objective imaging endpoints such as postoperative computed tomography (CT). In this study, we aimed to compare the procedural time and complications associated with fluoroscopy- and ultrasound-guided axillary and subclavian vein puncture techniques for pacemaker lead implantation. We conducted a retrospective analysis of 250 patients who underwent DDD pacemaker implantation for symptomatic bradycardia at Sakakibara Heart Institute between January 2021 and December 2023. The patients were categorized into two groups: fluoroscopy-guided (Group X, n = 147) and ultrasound-guided axillary or subclavian vein puncture (Group E, n = 103). The demographic data, number of punctures, and number of complications were analyzed. Among the 250 patients, postoperative chest CT scans were available for 75 to assess lead placement, focusing on intrathoracic lead insertion and distance from the lead to the outer edge of the clavicle. The mean age of the patients was 82 years, 46% were male, and the mean body mass index was 22 kg/m². The puncture time was significantly shorter in Group E than in Group X (5.6 ± 3.8 vs. 9.7 ± 10.3 min, p < 0.01). Patients in Group E had no puncture-related complications. Group X had more patients with the venous insertion point of the lead located within the thoracic cavity, as revealed by postoperative CT scans, than did Group E (8.0% vs. 0.6%, p < 0.01, respectively). Ultrasound-guided venous puncture reduced the puncture time, number of complications, and incidence of intrathoracic lead insertion. This technique may reduce lead stress and mitigate long-term lead-related complications.