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Wang Y, Zuo C, Wang X, Xiao Y, Zeng M, Yang Y, Chen Z. Effect of Bedside Ultrasound-Guided Versus Fluoroscopy-Guided Transvenous Cardiac Temporary Pacing in Children with Bradyarrhythmia. Pediatr Cardiol 2024:10.1007/s00246-024-03610-w. [PMID: 39096382 DOI: 10.1007/s00246-024-03610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
To compare the efficacy and safety of bedside ultrasound-guided and fluoroscopy-guided transvenous cardiac temporary pacing in the treatment of bradyarrhythmia in children. Children treated by temporary intravenous cardiac pacing from January 2016 to June 2023 in Hunan Provincial Children's Hospital were enrolled, and the characteristics and data of the cases were summarized. Patients were divided into bedside ultrasound-guided group (ultrasound group) and fluoroscopy-guided group (fluoroscopy group) according to the implantation guidance methods. The efficacy, safety, and incidence of complications in children were compared, and follow-up analysis was carried out. A total of 30 children were enrolled, including 18 males and 12 females, with a median age of 5.5 (2.9, 10.0) years and a median weight of 18.7 (12.7, 32.7) kg. The most common primary diseases were fulminant myocarditis (13/30 cases) and congenital high-grade AVB (10/30 cases). Among them, the proportion of congenital high AVB in the fluoroscopy group was significantly higher than that in the ultrasound group, and the difference was statistically significant (p = 0.007). The implantation process was successful in all 30 children. From the time of pacing decision to implantation, the median time of ultrasound group was 56 (30, 60) min and that of fluoroscopy group was 154 (78,180) min, with a statistically significant difference (P < 0.001). A total of 5 cases developed complications. There was no statistically significant difference between the two groups (P > 0.05). Compared with traditional fluoroscopic temporary pacing, bedside ultrasound-guided temporary pacing technology can effectively shorten the operation time and reduce the occurrence of complications and has become a better choice for children's emergency and critical care treatment. The right internal jugular vein is preferred for intravenous implantation.
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Affiliation(s)
- Yefeng Wang
- Department of Cardiology, Hunan Children's Hospital, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, No. 86 Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China
| | - Chao Zuo
- Department of Cardiology, Hunan Children's Hospital, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, No. 86 Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China
| | - Xiang Wang
- Department of Cardiology, Hunan Children's Hospital, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, No. 86 Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China
| | - Yunbin Xiao
- Department of Cardiology, Hunan Children's Hospital, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, No. 86 Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China
| | - Min Zeng
- Department of Cardiology, Hunan Children's Hospital, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, No. 86 Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China
| | - Yufan Yang
- Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, No. 86 Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China
| | - Zhi Chen
- Department of Cardiology, Hunan Children's Hospital, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, No. 86 Ziyuan Road, Changsha, 410007, Hunan, People's Republic of China.
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Avison A, Gelzer AR, Reef VB, Wulster Bills KB, de Solis CN, Kraus MS, Slack J, Stefanovski D, Deacon LJ, Underwood C. Twenty-four hour continuous transvenous temporary right ventricular pacing in healthy horses. J Vet Intern Med 2024; 38:1751-1764. [PMID: 38514200 PMCID: PMC11099695 DOI: 10.1111/jvim.17027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The ability to perform transvenous temporary cardiac pacing (TV-TP) is critical to stabilize horses with symptomatic bradyarrhythmias. Reports of successful TV-TP in horses are limited, and only briefly describe short-term pacing. OBJECTIVE To describe temporary, medium-term (24 h) transvenous right ventricular pacing in awake horses using a bipolar torque-directed pacing catheter. ANIMALS Six healthy adult institutional teaching horses. METHODS Prospective experimental study with 2 immediately successive TV-TP lead placements in each horse with a target location of the RV apex. One placement was performed primarily with echocardiographic guidance and 1 primarily with fluoroscopic guidance. In all placements, corresponding images were obtained with both imaging modalities. Horses were then paced for 24 h, unrestricted in a stall with continuous telemetric ECG monitoring. Echocardiographically determined lead position, episodes of pacing failure in the preceding 6 h, and pacing thresholds were recorded every 6 h. Pacing failure was defined as a period of loss of capture longer than 20 s. RESULTS Pacing leads were placed with both guidance methods and maintained for 24 h with no complications. Two horses with leads angled caudally in the right ventricular apex had no pacing failure, the remaining 4 horses had varying degrees of loss of capture. Leads located in the right ventricular apex had longer time to pacing failure and lower capture thresholds P < 0.05. CONCLUSIONS AND CLINICAL IMPORTANCE Medium-term TV-TP is feasible and has potential for stabilization of horses with symptomatic bradyarrhythmias. Lead position in the right ventricular apex appears optimal. Continuous ECG monitoring is recommended to detect pacing failure.
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Affiliation(s)
- Amanda Avison
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Anna R. Gelzer
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Virginia B. Reef
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Kathryn B. Wulster Bills
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Cris Navas de Solis
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Marc S. Kraus
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - JoAnn Slack
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Lindsay J. Deacon
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Claire Underwood
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
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Luke K, Milla C, Tandi JK, Julario R. Zero to minimal fluoroscopy for cardiac electronic device implantation: A systematic review and meta-analysis. J Arrhythm 2024; 40:38-46. [PMID: 38333407 PMCID: PMC10848632 DOI: 10.1002/joa3.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 02/10/2024] Open
Abstract
Background Fluoroscopy is conventionally performed for cardiac implantable electronic device (CIED) therapy and carries radiation drawback for both patients and medical workers. Recently, zero to minimal fluoroscopy (ZMF) approach is introduced to reduce radiation exposure of fluoroscopy. This study compares the feasibility and safety of ZMF approach to fluoroscopy for CIEDs therapy in adults. Method A systematic literature search was conducted on PubMed, ScienceDirect, and Web of Science in March 2023. All observational or experimental studies comparing ZMF approach to fluoroscopy for adult CIEDs therapy were included. Reviews, case report/series, animal studies, and non-English articles were excluded. The success rate, procedural time, fluoroscopy time, radiation dose, and complications rate were compared for each approach. Results Seven articles for permanent and three articles for temporary CIEDs were included for analysis. The success rate of ZMF for permanent CIEDs was similar to fluoroscopy method (OR: 0.77, 95% CI: 0.33-4.15). The procedural time of ZMF was similar to fluoroscopy for both permanent and temporary CIEDs (standardized mean difference [SMD]: 0.10, 95% CI: -0.35 to 0.55 and SMD: -0.71, 95% CI: -1.87-0.44, respectively). However, ZMF approach markedly reduced the fluoroscopy time and radiation exposure for permanent CIEDs (SMD: -1.80, 95% CI: -2.49 to -1.12 and SMD: -1.26, 95% CI: -2.24 to -0.29). The complication rate was similar for permanent CIEDs (OR: 1.08, 95% CI: 0.41-2.84), yet lowered for temporary CIEDs (OR: 0.34, 95% CI: 0.20-0.59). Conclusion ZMF had similar success rate, procedural time, and sum complication rate for permanent CIEDs implantation with a significant reduction of fluoroscopy time and radiation exposure.
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Affiliation(s)
- Kevin Luke
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | - Clonia Milla
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | | | - Rerdin Julario
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital‐Universitas AirlanggaSurabayaIndonesia
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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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Porciello F, Marchesi MC, Birettoni F, Spina F, Knafelz P, Bufalari A, Rishniw M, Moise NS, Caivano D. Transthoracic echo-guided pacemaker implantation reduces fluoroscopic use in dogs. Vet J 2021; 277:105762. [PMID: 34655788 DOI: 10.1016/j.tvjl.2021.105762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
Echocardiographic guidance provides an alternative method when fluoroscopy is unavailable, equipment or power failure of fluoroscopic equipment during a procedure occurs or to decrease radiation risk. Recently, transthoracic (TTE) and transesophageal echocardiography were reported as an alternative method to guide interventional procedures in dogs. Therefore, we hypothesized that TTE could be used as an alternative method to visualize endocardial leads during pacemaker implantation in dogs, largely avoiding the use of fluoroscopy. A prospective consecutive case series of pacemaker implantation was performed using TTE guidance. The endocardial lead was imaged by TTE during its intracardiac advancement until the lead tip was positioned at the right ventricular apex. Echocardiographic right parasternal views, optimized to visualize the pacing lead, were used, starting with a short axis image of the right atrium and ending with a long axis view of the right ventricle (RV) optimized to image the RV apex. Proper lead placement was confirmed by both capture threshold, impedance and fluoroscopy. Twenty-one pacemaker implantation procedures by TTE monitoring were successfully performed. The TTE guidance provided images of a quality sufficient to clearly monitor implantation in real-time and allowed for immediate corrections to pacing lead malpositioning or excessive looping. Fluoroscopy was used to confirm the correct placement of the lead that was guided echocardiographically in the initial three procedures, after which a single radiographic image (no cine-mode) was used to identify lead placement and redundancy in the remaining eighteen cases. Static imaging (radiography using the fluoroscope) was used to assess the proper lead redundancy in all procedures because this cannot be evaluated echocardiographically. Pacemaker leads were successfully implanted in the RV of dogs using TTE monitoring. A larger cases series is needed for validation of safety and effectiveness of TTE during this interventional procedure in dogs.
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Affiliation(s)
- F Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy.
| | - M C Marchesi
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - F Birettoni
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - F Spina
- Veterinary Hospital 'Etiopia', Viale Etiopia 16, Rome, 00199 Italy
| | - P Knafelz
- Veterinary Hospital 'GregorioVII', Piazza di Villa Carpegna 52, Rome, 00165 Italy
| | - A Bufalari
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - M Rishniw
- Veterinary Information Network, Davis, CA 95616, USA; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - N S Moise
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - D Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
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Cao Z, Xu J, Liu J, Wu M, Xie N, Guo X, Guo H, Wang S. Real-time three-dimensional transesophageal echocardiographic guidance versus fluoroscopic guidance for transvenous temporary cardiac pacemaker implantation during transcatheter aortic valve implantation surgeries. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1227. [PMID: 33178759 PMCID: PMC7607070 DOI: 10.21037/atm-20-5817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Fluoroscopic guidance is the traditional method for the implantation of transvenous temporary cardiac pacemakers (TVTPs). This study aimed to compare the time, effectiveness, and safety of real-time three-dimensional transesophageal echocardiography (3D TEE) with those of fluoroscopy in guiding TVTP implantation. Methods The records of patients who underwent transcatheter aortic valve implantation (TAVI) guided by real-time 3D TEE or fluoroscopy between July 1, 2016, and June 30, 2020, were retrospectively analyzed. TVTPs were implanted by anesthesiologists via the right internal jugular vein (IJV) in the real-time 3D TEE-guided group (3D TEE group), and by interventional cardiologists via the femoral vein in the fluoroscopy-guided group (fluoro group). Results A total of 143 patients (3D TEE-group n=79, and fluoro group n=64) were included. No statistical differences were observed in the baseline characteristics of the two groups. TVTPs were successfully implanted in all of the patients. The needle-to-pace time was significantly shorter in 3D TEE group than in fluoro group (5.2±2.9 vs. 8.5±4.6 min, P<0.001). Further, the incidence of access complications was significantly lower in 3D TEE group than in fluoro group (3.8% vs. 12.5%, P<0.05). One patient in fluoro group who suffered cardiac perforation underwent drainage via pericardiocentesis. No patients in either group died because of TVTP placement. The total complication rates were significantly lower in 3D TEE group than in fluoro group (19.0% vs. 39.1%, P<0.05). No statistically significant differences existed between groups in terms of pacing threshold, the incidence of permanent pacemaker insertion after surgery, the length of postoperative intensive care unit (ICU) stay, or the duration of postoperative hospitalization. Conclusions Real-time 3D TEE-guided can be used to effectively, quickly, and safely guide TVTP implantation. The procedure can be performed by properly trained anesthesiologists. Therefore, real-time 3D TEE is a suitable option for guiding perioperative TVTP implantation in patients undergoing cardiac surgery.
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Affiliation(s)
- Zhongming Cao
- Department of Anesthesiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jindong Xu
- Department of Anesthesiology, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Liu
- Department of Cardiac Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Min Wu
- Department of Cardiac Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Nianjin Xie
- Department of Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaogang Guo
- Department of Anesthesiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huiming Guo
- Department of Cardiac Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
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Qiu J, Wang Y, Chen G, Zhao C, Wang DW. Progress in zero-fluoroscopy implantation of cardiac electronic device. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:609-617. [PMID: 32348595 DOI: 10.1111/pace.13930] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Abstract
Fluoroscopy is the imaging modality routinely used for cardiac device implantation. Due to the rising concern regarding the harmful effects of radiation exposure to both the patients and operation staffs, many efforts have been made to develop alternative techniques to achieve zero-fluoroscopy implantation. In this review, we describe the different methods aimed at avoiding the application of fluoroscopy in recent years, and evaluate their feasibility and safety in cardiac electronic device implantation.
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Affiliation(s)
- Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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de Castro Galvão R, Papelbaum B, Almeida Lopes Neves R, Mantovani Cezar F, Dias de Jesus L, Correia Padilha J, Eduardo Duarte C, Medeiros de Vasconcelos JT, dos Santos Galvão-Filho S. Comparação entre 2 Métodos de Fixação de Marcapasso Provisório Transvenoso: FIX-IT Trial. JOURNAL OF CARDIAC ARRHYTHMIAS 2019. [DOI: 10.24207/jca.v32n2.007_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introdução: A necessidade de marcapasso provisório (MPP) transita por diversos cenários. Alguns pacientes necessitam do dispositivo para completar um tratamento de infecção, recuperar o ritmo após infarto do miocárdio ou enquanto aguardam liberação do dispositivo defi nitivo pela operadora de saúde. Independentemente da técnica de passagem do MPP, a boa fi xação do eletrodo é fundamental, evitando-se deslocamentos e necessidade de reposicionamento, entre outras complicações. Objetivo: Comparar duas formas de fi xação de MPP, uma sob fi xação direta na pele e outra mantendo-seo introdutor venoso conectado à proteção plástica por todo cabo-eletrodo do marcapasso. Métodos: Randomizaram-se 40 pacientes, 20 em cada grupo. Registraram-se dados referentes ao tempo do procedimento, posição do cabo-eletrodo, limiares de comando, sensibilidade e complicações. Consideraram-se como desfecho primário a necessidade de reposicionamento ou troca do MPP transvenoso e secundário qualquer complicação sem a necessidade de reposicioná-lo. Resultados: Não houve diferenças signifi cativas na duração total do procedimento entre os grupos na posição inicial do eletrodo e na via de acesso utilizada. O grupo com a proteção plástica apresentou desfecho primário maior (60%) em relação ao grupo de fi xação direta (20%; p = 0,0098). Não houve diferenças em relação ao desfecho secundário (p = 1,0). O grupo com proteção plástica também apresentou mais complicações totais em relação ao outro grupo (p = 0,0262). Conclusão: A fi xação direta do cabo-eletrodo do marcapasso se mostrou mais segura em relação à fi xação com proteção plástica, reduzindo complicações como deslocamentos do cabo-eletrodo que necessitem de reposicionamento ou troca desse, sem aumento no tempo do procedimento.
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de Castro Galvão R, Papelbaum B, Almeida Lopes Neves R, Mantovani Cezar F, Dias de Jesus L, Correia Padilha J, Eduardo Duarte C, Medeiros de Vasconcelos JT, dos Santos Galvão-Filho S. Comparison of Two Transvenous Temporary Pacemaker Fixation Methods: FIX-IT Trial. JOURNAL OF CARDIAC ARRHYTHMIAS 2019. [DOI: 10.24207/ca.v32n2.007_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: the necessity for a temporary pacemaker (TP) goes through several scenarios. Some patients require the device to complete an infection treatment, regain the pace after myocardial infarction, or while awaiting the release of the definitive device by the health care provider. Regardless of the TP passage technique, good electrode fixation is essential, avoiding dislocation and the necessity for repositioning, among other complications. Objective: to compare two forms of TP fixation, one under direct fixation to the skin and the other keeping the venous introducer connected to the plastic protection through the pacemaker electrode lead. Methods: Forty patients were randomized, 20 in each group. Data regarding the procedure time, electrode lead position, command thresholds, sensitivity, and complications were recorded. The primary outcome considered was the necessity for repositioning or exchange of transvenous TP and secondary any complication without the necessity to reposition it. Results: There were no significant differences in the total duration of the procedure between the groups in the initial position of the electrode and the access route used. The group with plastic protection had a higher primary outcome (60%) than the direct fixation group (20%; p = 0.0098). There were no differences regarding the secondary outcome (p = 1.0). The group with plastic protection also had more total complications compared to the other group (p = 0.0262). Conclusion: Direct fixation of the pacemaker electrode lead was safer concerning the fixation with plastic protection, reducing complications such as electrode dislocation requiring repositioning or replacement without increasing the procedure time.
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Sjaus A, Fayad A. The Use of Subcostal Echocardiographic Views to Guide the Insertion of a Right Ventricular Temporary Transvenous Pacemaker—Description of the Technique. J Cardiothorac Vasc Anesth 2019; 33:2797-2803. [DOI: 10.1053/j.jvca.2019.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Indexed: 11/11/2022]
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Tjong FVY, de Ruijter UW, Beurskens NEG, Knops RE. A comprehensive scoping review on transvenous temporary pacing therapy. Neth Heart J 2019; 27:462-473. [PMID: 31392624 PMCID: PMC6773795 DOI: 10.1007/s12471-019-01307-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transvenous temporary cardiac pacing therapy (TV-TP) is widely used to treat life-threatening arrhythmias. Yet aggregated evidence on TV-TP is limited. We conducted a systematic scoping review to evaluate indications, access routes and complications of TV-TP, as well as permanent pacemaker therapy (PPM) following TV-TP. Clinical studies concerning TV-TP were identified in Ovid MEDLINE. Case studies and studies lacking complication rates were excluded. To assess complication incidence over time, differences in mean complication rates between 10-year intervals since the introduction of TV-TP were evaluated. We identified 1398 studies, of which 32 were included, effectively including 4546 patients. Indications varied considerably; however TV-TP was most commonly performed in atrioventricular block (62.7%). The preferred site of access was the femoral vein (47.2%). The mean complication rate was 36.7%, of which 10.2% were considered serious. The incidence of complications decreased significantly between 10-year interval groups, but remained high in the most recent time period (22.9%) (analysis of variance; p < 0.001). PPM was required in 64.2% of cases following TV-TP. Atrioventricular block was the primary indication for TV-TP; however indications varied widely. The femoral vein was the most frequent approach. Complications are common in patients undergoing TV-TP. Although a decrease has been observed since its introduction, the clinical burden remains significant. The majority of patients who underwent TV-TP required PPM therapy.
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Affiliation(s)
- F V Y Tjong
- Heart Centre, Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands.
| | - U W de Ruijter
- Heart Centre, Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - N E G Beurskens
- Heart Centre, Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - R E Knops
- Heart Centre, Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
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Blanco P. Temporary transvenous pacing guided by the combined use of ultrasound and intracavitary electrocardiography: a feasible and safe technique. Ultrasound J 2019; 11:8. [PMID: 31359249 PMCID: PMC6638614 DOI: 10.1186/s13089-019-0122-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/05/2019] [Indexed: 11/24/2022] Open
Abstract
Temporary transvenous pacing is a crucial procedure in emergency and critical care medicine. While fluoroscopy guidance is considered the gold-standard to place the temporary pacing electrode catheter (EC), its use is usually limited by equipment availability and time. By contrast, ultrasound (US) guidance is a useful alternative, since it is widely available at the bedside, does not emit ionizing radiation and provides optimal times to active pacing with fewer complications. However, many times, in spite of visualizing the EC in the right ventricle using US, the pacing capture and sensing are not optimal, and thus, having an easily applicable method for best assessing this issue is desirable, especially if it could be combined with US without difficulties. With the purpose of illustrating the points made previously, the combined US-intracavitary electrocardiography technique is described in detail in this paper.
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Affiliation(s)
- Pablo Blanco
- Intensive Care Physician, Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., 7630, Necochea, Argentina.
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Ferri LA, Farina A, Lenatti L, Ruffa F, Tiberti G, Piatti L, Savonitto S. Emergent transvenous cardiac pacing using ultrasound guidance: a prospective study versus the standard fluoroscopy-guided procedure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:125-9. [PMID: 25673783 DOI: 10.1177/2048872615572598] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/22/2015] [Indexed: 11/17/2022]
Abstract
AIMS To compare time to active pacing and complication rates associated with temporary transvenous pacemaker (TTVPM) insertion between a fully echo-guided approach of vein access and lead placement, and standard placement of TTVPM under fluoroscopic guidance. METHODS AND RESULTS We performed a prospective single-center observational study enrolling all consecutive patients from 1 January 2008 to 31 December 2012 needing emergent TTVPM placement. According to personal experience and clinical setting, the operators could choose between a fully echo-guided approach of TTVPM placement through the jugular vein and a standard fluoro-guided approach through the femoral vein. Safety and efficacy endpoints were pre-specified, registered, and compared. A total of 113 patients were treated using the echo-guided approach, and 90 via the fluoro-guided approach. The two groups differed with regard to clinical setting at presentation: an acute coronary syndrome was more frequent in the fluoro-guided approach group (39.7% vs. 16.8%, p<0.001), whereas asystole was more frequent in the echo-guided approach group (9.7 vs. 0%). Median time from decision to active pacing was significantly shorter in the echo-guided approach group (22 vs. 43 minutes, p<0.01). The overall complication rates were significantly lower in the echo-guided approach group (15.0% vs. 28.8%, p 0.02), because of lower rates of infections (2.7% vs. 11.1%, p 0.02) and puncture-related hematomas (0 vs. 3.3%, p=0.08). There were no deaths related to TTVPM, but one heart perforation requiring emergent pericardiocentesis occurred in the fluoro-guided approach group. One pneumothorax treated conservatively occurred in the echo-guided approach group, while no differences were observed with regard to sustained tachyarrhythmias (1.8% vs. 2.2%) or malfunctions requiring reposition of the catheter (8.8 vs. 8.9%). Overall, complications delaying permanent pacemaker implant for >48 hours were observed less often in the echo-guided approach group (6.8 vs. 20.7%, p = 0.03). CONCLUSION Echo-guided insertion of TTVPM through the jugular vein is a feasible and safe alternative to fluoroscopic guidance and may reduce complications and time to active pacing in patients who are not candidates for emergent cardiac catheterization.
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Affiliation(s)
- Luca A Ferri
- Cardiovascular Department, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Andrea Farina
- Cardiovascular Department, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Laura Lenatti
- Cardiovascular Department, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Franco Ruffa
- Cardiovascular Department, Ospedale Alessandro Manzoni, Lecco, Italy
| | - GianLuca Tiberti
- Cardiovascular Department, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Luigi Piatti
- Cardiovascular Department, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Stefano Savonitto
- Cardiovascular Department, Ospedale Alessandro Manzoni, Lecco, Italy
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Kumar B, Dutta V, Mishra A, Mishra AK. Intraoperative Transesophageal Echocardiography for Positioning Transvenous Temporary Pacing Wire. J Cardiothorac Vasc Anesth 2015; 29:e2-3. [DOI: 10.1053/j.jvca.2014.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Indexed: 11/11/2022]
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Renilla A, Barreiro M, Rubín JM, de la Hera JM. [Provisional pacemaker implantation guided by pocket echocardiography]. Med Intensiva 2012; 37:54-6. [PMID: 22683045 DOI: 10.1016/j.medin.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/04/2012] [Indexed: 11/19/2022]
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