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Howard TS, Vinocur JM. Translation of Tools and Techniques from the Adult Electrophysiology World to Pediatric Cardiac Implantable Electronic Devices. Card Electrophysiol Clin 2023; 15:515-525. [PMID: 37865524 DOI: 10.1016/j.ccep.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
This article reviews various opportunities to translate established and novel tools and techniques used in adult electrophysiology to pediatrics and the adult congenital heart disease population. There is a specific focus on preoperative management of special population, implantation techniques, and postoperative programming of devices.
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Affiliation(s)
- Taylor S Howard
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX 77030, USA.
| | - Jeffrey M Vinocur
- Department of Pediatrics, Division of Pediatric Cardiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
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Mian M, Khan HR. Ultrasound utilization for implantation of cardiac implantable electronic devices. Wien Klin Wochenschr 2023; 135:712-718. [PMID: 37353694 PMCID: PMC10713767 DOI: 10.1007/s00508-023-02215-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/20/2023] [Indexed: 06/25/2023]
Abstract
Ultrasound (US) guidance for implantation of cardiac implantable electronic devices (CIED) is currently not routine practice. This article sought to review published data on the use of ultrasound in each of the major surgical steps involved in implantation of CIEDs, including achieving anesthesia, obtaining venous access and implantation of leads. A literature review was performed, revealing a total of 20 peer-reviewed studies that assessed US guidance for CIED implantation; 3 of these were randomized trials while the remainder were mostly feasibility studies. The available data suggest that ultrasound can be useful in guiding implantation of CIEDs, with a trend towards less complication rates; however, more high-quality studies that compare US guidance to traditional techniques in CIED implantation are required.
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Affiliation(s)
- Muhtashim Mian
- University Hospital, University of Western Ontario, 339 Windermere Rd., N6A 5A5, London, Ontario, Canada
| | - Habib Rehman Khan
- University Hospital, University of Western Ontario, 339 Windermere Rd., N6A 5A5, London, Ontario, Canada.
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Xu R, Huang X, Guo P, Cai H, Feng S, Lin Z. Ultrasound-guided pacemaker implantation at the bedside: A lifesaving technique for cardiac emergencies. Ann Noninvasive Electrocardiol 2023; 28:e13071. [PMID: 37469208 PMCID: PMC10475883 DOI: 10.1111/anec.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE To investigate the safety and effectiveness of implanting temporary pacemakers using ultrasound-guidance at the bedside for rescuing patients in case of cardiac emergencies. METHODS We enrolled 194 patients with cardiac emergencies requiring temporary pacemakers in this study, and randomly assigned them to either a bedside ultrasound-guided installation group or an electrocardiogram-guided installation group. There were 105 cases in the bedside ultrasound-guided installation group, aged approximately 66.3 ± 10.2 years, and 89 cases in the electrocardiogram-guided installation group, aged approximately 65.8 ± 9.5 years old, and disease composition was similar between the two groups. We then compared the duration of the procedure, success rates, and occurrence of adverse events between the two groups. RESULTS The two groups showed similar clinical characteristics. The success rates of venipuncture and temporary pacemaker electrode placement were both 100% in the bedside ultrasound-guided installation group, compared to 87.8% and 96.7% respectively, in the electrocardiogram-guided installation group, with a statistically significant difference between the two groups. The duration of puncture was significantly shorter in the bedside ultrasound-guided installation group than in the electrocardiogram-guided installation group, with statistically significant differences. Moreover, no adverse events such as hematoma, pneumothorax and electrode dislodgement occurred in the bedside ultrasound-guided installation group, while 13 cases in the electrocardiogram-guided installation group experienced adverse events, and the difference was statistically significant. CONCLUSIONS The bedside installation of temporary pacemakers using ultrasound guidance is a simple, safe, effective, and cost-efficient procedure that boasts a high success rate, does not involve radiation, and enables accurate placement of the electrode catheter.
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Affiliation(s)
- Rong‐Quan Xu
- Department of Ultrasound MedicineThe First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Department of Ultrasound Medicine, National RegionalMedical CenterBinhai Campus of the First Affiliated Hospital Fujian Medical UniversityFuzhouChina
| | - Xiao‐Feng Huang
- Department of EmergencyThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of EmergencyNational RegionalMedical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical UniversityFuzhouChina
| | - Ping‐Qing Guo
- Department of EmergencyThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of EmergencyNational RegionalMedical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical UniversityFuzhouChina
| | - Hong‐Bin Cai
- Department of Cardiovascular MedicineThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of Cardiovascular MedicineNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical UniversityFuzhouChina
| | - Shao‐Dan Feng
- Department of EmergencyThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of EmergencyNational RegionalMedical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical UniversityFuzhouChina
| | - Zhi‐Hong Lin
- Department of EmergencyThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of EmergencyNational RegionalMedical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical UniversityFuzhouChina
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D'Arrigo S, Perna F, Annetta MG, Pittiruti M. Ultrasound-guided access to the axillary vein for implantation of cardiac implantable electronic devices: A systematic review and meta-analysis. J Vasc Access 2023; 24:854-863. [PMID: 34724839 DOI: 10.1177/11297298211054621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aims of our systematic review were to quantify the expected rate of procedural success, early and late complications during CIED implantation using US-guided puncture of the axillary vein and to perform a meta-analysis of those studies that compared the US technique (intervention) versus conventional techniques (control) in terms of complication rates. MEDLINE, ISI Web of Science, and EMBASE were searched for eligible studies. Pooled Odds Ratio (OR) and Pooled Mean Difference (PMD) for each predictor were calculated. The quality of evidence (QOE) was evaluated according to the GRADE guidelines. Thirteen studies were included a total of 2073 patients. The overall success of US-guided venipuncture for CIED implantation was 96.8%. As regards early complications, pneumothorax occurred in 0.19%, arterial puncture in 0.63%, and severe hematoma/bleeding requiring intervention in 1.1%. No cases of hemothorax, brachial plexus, or phrenic nerve injury were reported. As regards late complications, the incidence of pocket infection, venous thromboembolism, and leads dislodgement was respectively 0.4%, 0.8%, and 1.2%. In the meta-analysis (five studies), the intervention group (US-guided venipuncture) had a trend versus a lower likelihood of having a pneumothorax (0.19% vs 0.75%, p = 0.21), pocket hematoma (0.8% vs 1.7%, p = 0.32), infection (0.28% vs 1.05%, p = 0.29) than the control group, but this did not reach statistical significance. The overall QOE was low or very low. In conclusions we found that the US-guided axillary venipuncture for CIEDs implantation was associated with a low incidence of early and late complications and a steep learning curve.
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Affiliation(s)
- Sonia D'Arrigo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Salcedo J. Ultrasound-guided vascular access for CIED implantation: A step-by-step guide. J Cardiovasc Electrophysiol 2023; 34:1033-1036. [PMID: 36786522 DOI: 10.1111/jce.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/10/2023] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Vascular access is required for most cardiac electrophysiology procedures. Over the past 2 decades, ultrasound guidance has increased in utilization as the primary method for assisting operators in gaining access to cardiac implantable electronic device (CIED) implantation. METHODS Ultrasound guidance using a technique that includes both short-axis and long-axis views combined with a twisting needle motion after maximal tenting provides an extremely safe and reproducible technique for vascular access for all CIED procedures. RESULTS AND CONCLUSIONS In this manuscript and accompanying videos, a step-by-step guide is explained for optimal ultrasound-guided visualization and needle maneuver technique to maximize safety and efficiency for vascular access in all CIED procedures.
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Affiliation(s)
- Jonathan Salcedo
- Palo Alto Medical Foundation-Sutter Health, Palo Alto, California, USA.,Silicon Valley Cardiology, Sequoia Hospital, Redwood City, California, USA
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Courtney AM, Chandler JK, Anderson J, Shrestha A, Noheria A, Pimentel R, Dendi R, Ramirez R, Reddy YM, Sheldon SH. UltraSound Axillary Vein Access (USAA): Learning curve and randomized comparison to traditional venous access for cardiac device implantation. Pacing Clin Electrophysiol 2022; 45:1364-1371. [PMID: 36270271 DOI: 10.1111/pace.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/13/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many techniques exist for venous access (VA) during cardiac implantable electronic device (CIED) implantation. OBJECTIVE We sought to evaluate the learning curve with ultrasound (US) guided axillary vein access (USAA). METHODS Single-center prospective randomized controlled trial of patients undergoing CIED implantation. Patients were randomized in a 2:1 fashion to USAA versus conventional VA techniques. The primary outcomes were the success rates, VA times and 30-day complication rates. RESULTS The study included 100 patients (age 68 ± 14 years, BMI 27 ± 4 kg/m2 ). USAA was successful in 66/70 implants (94%). Initial attempts at conventional VA included 47% axillary (n = 14), 30% (n = 9) cephalic, and 23% (n = 7) subclavian. The median access time was longer for USAA than conventional access (8.3 IQR 4.2-15.3 min vs. 5.2 IQR 3.4-8.6 min, p = .009). Among the five inexperienced USAA implanters, there was a significant improvement in median access time from first to last tertile of USAA implants (17.0 IQR 7.0-21.0 min to 8.6 IQR 4.5-10.8 min, p = .038). The experienced USAA implanter had similar access times with USAA compared with conventional access (4.0 IQR 3.3-4.7 min vs. 5.2 IQR 3.4-8.6 min, p = .15). Venograms were less common with USAA than conventional access (2% vs. 33%, p < .0001). The 30-day complication rate was similar with USAA (n = 4/70, 6%) versus conventional (n = 3/30, 10%, p = .44). CONCLUSION Although the success rate with USAA was high, there was a significant learning curve. Once experienced with the USAA technique, there is the potential for reduced complications without adding to the procedure duration.
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Affiliation(s)
- Alex M Courtney
- School of Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Jonathan K Chandler
- Department of Internal Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - John Anderson
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Shrestha
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rhea Pimentel
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Raghuveer Dendi
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Rigoberto Ramirez
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Y Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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Qin D, Ptaszek LM. A Practical Guide to Ultrasound-guided Venous Access During Implantation of Pacemakers and Defibrillators. J Innov Card Rhythm Manag 2022; 13:4873-4877. [PMID: 35251755 PMCID: PMC8887928 DOI: 10.19102/icrm.2022.130204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022] Open
Abstract
Ultrasound (US) guidance has been shown to be a safe and effective option for gaining access to the axillary vein during implantation of cardiovascular implantable electronic devices (CIEDs). However, US-based technique has not been universally adopted in CIED implantations performed in cardiac electrophysiology (EP) laboratories, despite potential advantages over other vascular access techniques. For this reason, not all cardiac electrophysiologists have been trained to use US guidance during CIED implantation. This review is intended to provide a practical guide to the use of US guidance to obtain axillary vein access in the EP laboratory setting.
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Affiliation(s)
- Dingxin Qin
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Leon M Ptaszek
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
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