Abstract 17876: Outcome of Ultrasound versus Fluroscopy Guided PPM Implantation

Abstract

Introduction: Universal standard practice for venous access for implanting permanent pacemaker (PPM) is with fluoroscopy with venogram. Ultrasound (US) guided vascular access is increasingly encouraged to minimise radiation, contrast load and inadvertent injury to other structures. The incidence of US-guided vascular access related complications is unknown. Goals: To compare complications including radiation exposure with Ultrasound (US) guided vascular access, compared with fluoroscopy/venogram access. Method: Retrospective data of 205 consecutive patients implanted with PPM (elective and urgent) from August 2021 to August 2022 at single centre were collated for access-related complications and cumulative entire-procedure radiation dose. Result: 149/205 (73%) patients underwent fluoroscopy guided subclavian/axillary/cephalic vein versus access and 55/205 (27%) US-guided access. Fluoroscopy guided access was associated with complication rate of 6.8% (14/205), compared with 0.97% (2/205) for US-guided access (p=0.3602; Fisher exact test). There were no differences in radiation dosage between the two groups (p=0.1917). Conclusion: There were no statistically significant differences in vascular access-related complications or radiation dose between fluoroscopy guided and US-guided venous access for PPM implantation. US-guided access was however associated with lower complication rates. Larger robust randomized controlled trials would be required to validate these finding.