Key result
TTE-fluoroscopy guidance enables leadless pacemaker implantation with minimal or no contrast.
Why the study?
Leadless pacemakers reduce lead-related complications but can cause serious access site bleeding and cardiac perforation, and traditional implantation relies on fluoroscopy and contrast.
Provides a technical overview and step-by-step instructions for using transthoracic echocardiography to guide leadless pacemaker implantation with minimal contrast.
May enable contrast-sparing leadless pacemaker implantation; leaves open prospective validation of safety and outcomes.
Leadless pacemakers (LPs) have emerged as an alternative therapy to the transvenous system for patients who require a permanent pacemaker. Despite the reduced risks of lead-related complications, devastated complications with LP can occur, including access site bleeding and cardiac perforation. Traditionally, ventricular LP implantation requires fluoroscopy and contrast/ventriculogram to guide septal placement, with the use of transesophageal echocardiogram or intracardiac echocardiogram in certain complex cases. We previously reported a novel technique of using a transthoracic echocardiogram implemented with fluoroscopy to guide LP implantation with minimal/no contrast utilization, which has been the primary imaging modality during ventricular LP implantation at our institution. This article provides a technical overview and step-by-step instructions on using ultrasound to guide LP implantation.
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Kewcharoen et al. (2025) conducted a review in Patients requiring a permanent pacemaker. Ultrasound-guided leadless pacemaker implantation was evaluated. A technical overview and step-by-step instructions are provided for using transthoracic echocardiogram with fluoroscopy to guide leadless pacemaker implantation with minimal or no contrast.
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