A Safe and rapid technique for pacemaker İmplantation: Roadmap-guided subclavian vein puncture

Objective: Widely used method is blinded puncture of subclavian vein, but the complication rate is high in this method. In this study, we aimed to demonstrate the effect of roadmap use during implantation of permanent pacemaker on the success rate, speed of puncture and complications. Methods: The study was designed as a prospective randomized controlled study. Totally, 125 devices were implanted to the patients included in the study, and 518 punctures were performed for implantation of these devices. 186 punctures were performed in roadmap group and 332 punctures were performed in conventional group. Two groups were compared with regard to clinical and demographic features, speed and success of puncture and complications. Results: Baseline characteristics were similar between groups. Median duration of intervention for each puncture was 27 (15/46) s in roadmap group and 56 (30/100) s in conventional group. The number of attempts for a successful puncture was detected as 1 (1/2) in roadmap group and 2 (2/4) in conventional group. Arterial puncture incidence was 10.3% in roadmap group and 37% in conventional group (P < 0.001 for all). Considering complications, the incidence of pneumothorax and intramuscular puncture was seen lower significantly (P = 0.046 and P = 0.006, respectively). Conclusion: Number of attempts for successful puncture, time needed for successful puncture, number of arterial puncture and complication rate was significantly lower in patients undergoing pacemaker implantation by roadmap technique. Based on these data, roadmap technique may take the place of conventional method of puncture.