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Adoption of an echo-guided axillary puncture workflow is associated with faster procedural duration in transvenous pacemaker implantation
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 05 – AVANÇOS NA GESTÃO DO RITMO CARDÍACO: UM OLHAR SOBRE AS INOVAÇÕES E OS RESULTADOS DO PACING
Speaker:
Guilherme Portugal
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Guilherme Portugal; Francisco Barbas Albuquerque; Catia Guerra; Rita Contins; Manuel Bras; Ana Sofia Delgado; Margarida Paulo; Sofia Jacinto; Pedro Silva Cunha; Rui Cruz Ferreira; Mario Martins Oliveira
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Introduction</span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Echo-guided venous access for the implantation of transvenous leads in cardiac device recipients is a class I recommendation in the current EHRA guidelines. However, many centers are still performing conventional anatomical or fluoro-guided venous puncture due to barriers related to equipment availability, operator learning curve and subjective perception of a longer procedural time. Our aim was to analyze the impact of the systematic adoption of an echo-guided workflow on transvenous pacemaker (PM) implantation.</span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Methods</span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We retrospectively analyzed a cohort of patients (P) submitted to transvenous PM lead implantation employing an axillary echo-guided puncture. An historical cohort from 2019 to 2021 was employed as a control group. Baseline characteristics, procedural data and outcomes were reviewed. Multivariate linear regression analysis was employed to determine baseline predictors of procedural duration.</span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Results</span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 530 PM implantations were included, of which 59% were dual-chamber (DDD) corresponding to 841 implanted leads. The mean age was 79.4 +/- 10.4 years and 41.1% were male. The indication for pacing was atrioventricular block in 67.2%, sinus node disease in 20.5% and binodal disease in the remaining 12.2%. There were 392 patients in the conventional group and 138 in the echo-guided group. No significant differences were observed between groups regarding baseline characteristics (p=ns for all). Axillary access was successful in 137 patients (99.2%), with one bailout to a cephalic cutdown technique. Two pneumothoraxes were observed in the conventional group and one pneumothorax in the echo-guided group (p=NS), while using the short-axis technique in the initial 30 patients. No other complications were observed after switching the echo-guided approach to a long-axis technique. Mean procedural duration for all P was 47.9 +/- 22.7 minutes, which was 6.3 minutes lower in the echo-guided group (43.1 +/- 21.4 vs. 49.5 +/- 22.9; p=0.004). After multivariate linear regression analysis, DDD PM (7.9 +/- 2.0 mins, p<0.001) and echo-guided puncture (-5.9 +/- 2.2 mins, p=0.007) were the only significant predictors of procedural duration. </span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Conclusion</span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The adoption of an echo-guided workflow for the implantation of transvenous leads has a high success rate and is associated with a decrease in procedural duration, even when considering the initial learning curve. </span></span></span></p>
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