超声引导与透视引导下心脏植入式电子装置植入时腋静脉穿刺的比较：一项纳入1257例患者的荟萃分析
Ultrasound-guided versus fluoroscopy-guided axillary vein puncture for cardiac implantable electronic device implantation: a meta-analysis enrolling 1257 patients.
作者信息
Vetta Giampaolo, Parlavecchio Antonio, Wright Jennifer, Magnocavallo Michele, Marcon Lorenzo, Doundoulakis Ioannis, Scacciavillani Roberto, Sorgente Antonio, Pannone Luigi, Almorad Alexandre, Sieira Juan, Audiat Charles, Nakasone Kazutaka, Bala Gezim, Ströker Erwin, Overeinder Ingrid, Rossi Pietro, Sarkozy Andrea, Chierchia Gian-Battista, de Asmundis Carlo, Della Rocca Domenico Giovanni
机构信息
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy.
出版信息
J Interv Card Electrophysiol. 2024 Oct 24. doi: 10.1007/s10840-024-01932-6.
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.
引言
超声引导下（超声引导腋静脉穿刺术，Echo - AVP）和荧光透视引导下腋静脉穿刺术（荧光透视引导腋静脉穿刺术，Fluoro - AVP）均被认为是用于心脏植入式电子设备（CIEDs）经静脉植入导线的安全有效技术。尽管如此，关于这两种技术中哪一种具有更好的安全性和有效性仍存在争议。因此，我们进行了一项荟萃分析，以评估Echo - AVP与Fluoro - AVP用于CIEDs植入的有效性和安全性。
方法
我们系统检索了截至2024年5月15日的Medline、Embase和Cochrane电子数据库，以查找评估Echo - AVP和Fluoro - AVP的有效性和安全性且报告至少一项感兴趣的临床结局的研究。主要疗效终点是急性手术成功率，主要安全终点是气胸、囊袋血肿/出血、囊袋感染和意外动脉穿刺的复合终点。效应量使用随机效应模型估计为比值比（OR）和均值差（MD）以及相对95%置信区间（CI）。
结果
总体而言，纳入了4项研究，共1257例患者（Echo - AVP：373例患者；Fluoro - AVP：884例患者）。Echo - AVP导致主要安全终点（OR：0.41；p = 0.0009）、意外动脉穿刺风险（OR：0.29；p = 0.003）和透视时间（MD： - 105.02；p = 0.008）显著降低。在急性手术成功率（OR：0.77；p = 0.27）、气胸（OR：0.66；p = 0.60）、囊袋血肿/出血（OR：0.68；p = 0.30）、囊袋感染（OR：0.66；p = 0.60）、手术时间（MD：1.99；p = 0.65）、首次尝试成功率（OR：1.25；p = 0.34）和静脉穿刺时间（MD： - 0.25；p = 0.99）方面，Echo - AVP与Fluoro - AVP之间未发现差异。
结论
与Fluoro - AVP相比，Echo - AVP被证明可显著降低主要安全终点、意外动脉穿刺和透视时间。
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