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Predictors of successful ultrasound‐guided lead implantation
Author(s) -
Ahmed Asim S.,
Gilge Jasen L.,
Clark Brad A.,
Shah Ankur,
Bagga Shiv,
Padanilam Mathew S.,
Prystowsky Eric N.,
Joshi Sandeep A.,
Nair Girish V.,
Patel Parin J.
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13855
Subject(s) - medicine , pneumothorax , axillary vein , fluoroscopy , hematoma , surgery , lead (geology) , ultrasound , vein , radiology , thrombosis , geology , geomorphology
Background Technical advances have improved the safety of cardiac implantable electronic device (CIED) insertion, but periprocedural complications persist. Despite ultrasound (US) guidance for vascular access being feasible and exhibiting shorter fluoroscopy times, it is not widely adopted for insertion of CIEDs. Thus, we studied the use of US for CIED insertion to (1) quantify the success rate of venous cannulation, (2) identify predictors of failed cannulation, and (3) quantify the rate of complications using US guidance. Methods We studied 166 consecutive patients who underwent US‐guided CIED implantation. Anatomic parameters of the axillary vein were measured. The primary outcome was success (group 1) or failure (group 2) to obtain vascular access utilizing US guidance. Secondary outcomes included pneumothorax and hematoma. Results Successful US‐guided cannulation occurred in 154 of 166 patients (93%). No patient had a pneumothorax. Hematoma occurred in 1 of 166 patients (0.01%). Group 2 exhibited higher male proportion at 11 of 12 (92%) compared with 94 of 154 (61%) in group 1 ( P = .03), increased vein depth at 3.84 versus 2.85 cm ( P = .003), more right‐sided implants ( P = .03), higher weight at 104.6 versus 85.3 kg ( P = .017), higher body mass index at 35.6 versus 29.2 kg/m 2 ( P = .049), and higher body surface area at 2.24 versus 1.99 m 2 ( P = .013). Other parameters were statistically nonsignificant. In multivariate analysis, vein depth remained significantly associated with failure. Conclusion Using US guidance for CIED implantation is successful in the vast majority (93%) of patients. Rare cases of unsuccessful cannulation were associated with right‐sided implants and increased venous depth.