Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

Abstract

Background Permanent cardiac implantable electronic devices (CIEDs) are traditionally implanted with the assistance of fluoroscopy. While clinically effective, this technique exposes both patients and providers to radiation which is associated with adverse health effects and represents an occupational hazard. In this study, we investigate the safety and feasibility of permanent CIED placement under the guidance of transthoracic echocardiography (TTE). There is also increasing interest in use of non‐fluoroscopic options for noninvasive cardiac electrophysiologic procedures. Methods Fifteen patients consecutively consented for initial implant of CIEDs, specifically dual chamber pacemakers (DCPM) and dual chamber implantable cardioverter defibrillators (DCICDs). Patients were excluded if they had previous implants, abandoned leads, or anatomic anomalies including congenital and known persistent left superior vena cava (PLSVC). We used TTE to guide and implant atrial and ventricular leads. Results Eleven patients received DCPMs and four patients received DCICDs. The procedure duration was 49.3 min for DCICD and 52.3 min for DCPM, p = .807. The average number of right atrial lead attempts was 1.6 for DCPMs and 1.8 for DCICD, p = .860. The average number of right ventricular lead attempts for DCPMs was 2.2 and 1.0 attempt for DCICDs, p = .044. There were no complications at 90‐day follow‐up. Conclusion We demonstrate the feasibility of TTE‐guided DCPM/DCICD implantation without use of fluoroscopy. We present this method as a safe alternative for permanent CIED placement that may reduce risk of radiation exposure and cost while maintaining safety and efficacy. No operators wore lead aprons during the procedure.

Comparison of clinical outcomes between transthoracic echocardiography and X‐ray guided left bundle branch pacing for bradycardia: A randomized control trial

“…A fluoroless implant with echocardiography in conventional pacing has been demonstrated in the literature, 4 however direct visualization of the lead in LBBAP with echocardiography and the associated benefits has not undergone extensive review. The authors hypothesize reduction in procedural and fluoroscopic times in patients who undergo lead implant guided by direct visualization with TTE compared with conventional fluoroscopic guided implants.…”

“…A fluoroless implant with echocardiography in conventional pacing has been demonstrated in the literature, 4…”

Zero-Fluoroscopy Pacemaker Implantation

“…A case series using TTE to guide dual-chamber CIED implantation did place a right atrial and right ventricular lead without fluoroscopy except for fluoroscopy at the end of the procedure to check lead position. 16 It would seem likely that fluoroscopy to assess final lead position and slack would be desirable in most patients, given that if repositioning is needed after the patient has left the implantation room that could increase the risk of infection.…”