Efficiency and safety analysis of ultrasound-guided vs fluoroscopy-guided venous access for implantation of cardiac electronic devices

Background Ultrasound-guided venous access (UGVA) has been adopted by many procedural fields and has the advantage of forgoing radiation exposure to patients. To date, there are only small retrospective studies and a few randomized controlled trials that have evaluated short-term data regarding the safety and efficiency of ultrasound-guided placement of cardiac electronic devices (CED). Implantation of cardiac electronic devices still utilizes fluoroscopy intra-procedurally however limiting radiation through the use of ultrasound-guided access can be beneficial in the long term. More data is required to assess complication rates and analyze if the minimizing of radiation exposure during access is significant. Methods We conducted a retrospective analysis of patients who underwent placement of CED at a tertiary care center from Jan 2023 to Dec 2023. We used multivariable logistic and linear regression models as appropriate to compare safety and efficiency of UGVA and fluoroscopy-guided venous access (FGVA). Results A total of 514 CEDs were placed during the year of 2023. The UGVA cohort included 297 patients and FGVA group had 217 patients. Overall, there was no significant difference in procedure time or cumulative radiation between the two groups when adjusted for number of leads placed. There were no complications in the UGVA cohort and one pneumothorax sustained in the FGVA group. Conclusion Our data support that the use of UGVA for implantation of CEDs is safe and effective without any significant difference in procedure time. Despite the theoretical benefits of UGVA, it was not found to have a significant impact on cumulative radiation exposure as compared to FGVA.