Cardiology Department, Sant'Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.
Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
Europace. 2024 Nov 1;26(11). doi: 10.1093/europace/euae274.
The use of ultrasound (US)-guided venous puncture for cardiac pacing/defibrillation lead placement may minimize the risk of periprocedural complications and radiation exposure. However, none of the published studies have been sufficiently powered to recommend this approach as the standard of care. We compare the safety and efficacy of ultrasound-guided axillary venous puncture (US-AVP) vs. fluoroscopy-guided access for cardiac implantable electronic devices (CIEDs) by performing an individual patient data meta-analysis based on previously published studies.
We conducted a thorough literature search encompassing longitudinal investigations (five randomized and one prospective studies) reporting data on X-ray-guided and US-AVP for CIED procedures. The primary endpoint was to compare the safety of the two techniques. Secondary endpoints included the success rate of each technique, the necessity of switching to alternative methods, the time needed to obtain venous access, X-ray exposure, and the occurrence of periprocedural complications. Six longitudinal eligible studies were identified including 700 patients (mean age 74.9 ± 12.1 years, 68.4% males). The two approaches for venous cannulation showed a similar success rate. The use of an X-ray-guided approach significantly increased the risk of inadvertent arterial punctures (OR: 2.15, 95% CI: 2.10-2.21, P = 0.003), after adjustment for potential confounders. Conversely, a US-AVP approach reduces time to vascular access, radiation exposure, and the number of attempts to vascular access.
The US-AVP enhances safety by reducing radiation exposure and time to vascular access while maintaining a low rate of major complications compared to the X-ray-guided approach.
PROSPERO identifier: CRD42024539623.
超声（US）引导下的静脉穿刺用于心脏起搏/除颤导线放置可最大程度降低围手术期并发症和辐射暴露的风险。然而，发表的研究均未充分有力地推荐这种方法作为标准治疗。我们通过基于先前发表的研究进行个体患者数据荟萃分析，比较超声引导下腋静脉穿刺（US-AVP）与透视引导下心内植入式电子设备（CIED）的安全性和有效性。
我们进行了全面的文献检索，包括对 X 射线引导和 US-AVP 用于 CIED 手术的纵向研究（五项随机研究和一项前瞻性研究）。主要终点是比较两种技术的安全性。次要终点包括两种技术的成功率、需要切换到替代方法的必要性、获得静脉通路所需的时间、X 射线暴露以及围手术期并发症的发生。确定了六项符合条件的纵向研究，共纳入 700 例患者（平均年龄 74.9±12.1 岁，68.4%为男性）。两种静脉穿刺方法的成功率相似。使用 X 射线引导方法会显著增加意外动脉穿刺的风险（OR：2.15，95%CI：2.10-2.21，P=0.003），在调整了潜在混杂因素后。相反，US-AVP 方法可减少到达血管的时间、辐射暴露和到达血管的尝试次数。
与 X 射线引导方法相比，US-AVP 通过减少辐射暴露和到达血管的时间，同时保持较低的主要并发症发生率，提高了安全性。
PROSPERO 标识符：CRD42024539623。
