Outcome of Ultrasound-Guided Versus Fluoroscopy-Guided Versus Cephalic Cutdown Permanent Pacemaker Implantation

Area of Science:

• Cardiology
• Medical Imaging
• Surgical Procedures

Background:

• Fluoroscopy with venogram is standard for central venous access in permanent pacemaker (PPM) implantation.
• Ultrasound-guided access is promoted to reduce radiation, contrast, and injury, but its complication profile in PPM procedures is unclear.
• This study compares complications and radiation exposure for ultrasound-guided, fluoroscopy-guided, and cephalic vein cutdown access methods.

Purpose of the Study:

• To compare access-related complications between ultrasound-guided, fluoroscopy-guided, and cephalic vein cutdown for PPM implantation.
• To analyze and compare radiation exposure across the three different central venous access methods.
• To evaluate the safety and effectiveness of ultrasound-guided access in PPM procedures.

Main Methods:

• Retrospective cross-sectional study of 202 patients undergoing PPM implantation (August 2021-August 2022).
• Access methods included ultrasound-guided (n=56), fluoroscopy-guided (n=114), and cephalic cutdown (n=32).
• Access-related complications (arterial puncture, hematoma, pneumothorax, lead/device failure, procedure failure) and radiation dose were analyzed.

Main Results:

• Complication rates were 5.4% (ultrasound), 9.6% (fluoroscopy), and 9.4% (cephalic cutdown), with no statistically significant difference (p=0.62).
• Radiation dose varied significantly (p < 0.001), with median exposures: 10.1 mGy (cephalic), 13.4 mGy (ultrasound), and 19.2 mGy (fluoroscopy).
• Ultrasound-guided access demonstrated an intermediate radiation profile between cephalic cutdown and fluoroscopy-guided procedures.

Conclusions:

• Ultrasound-guided access showed the lowest complication rate, though not statistically significant, likely due to sample size.
• Radiation exposure was significantly lower with cephalic cutdown and ultrasound guidance compared to fluoroscopy.
• Findings support the safety of ultrasound-guided access for PPM implantation, warranting larger studies to confirm its role in reducing complications and radiation.