Comparison between thoracic ultrasound and chest x-ray in non-infective early complications detection after cardiac implantable electronic devices implantation procedures

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background In the immediate postoperative of cardiac implantable electronic devices (CIED) implantation procedures, literature and practice suggest the use of chest radiography as a gold standard diagnostic tool for early local complications such as pneumothorax, hemothorax and pericardial effusion. The introduction of bedside thoracic ultrasound into clinical practice guarantees a tool that is easy to use and highly appropriate for the early diagnosis of pleural pathologies. However, its use in the context of cardiac stimulation is not yet validated and is not mentioned in international consensus documents. Purpose The purpose of this study was to evaluate the rate of early mechanical complications in the post-implantation of cardiac stimulation devices and to compare the diagnostic power of the two methods. Methods 397 consecutive patients who underwent intracavitary device implantation or upgrade with the puncture of a central venous vessel were prospectively enrolled in a multicenter study from November 1, 2021, to September 30, 2022. In the two days following surgery, all patients underwent chest radiography, when possible in the supine position, and chest ultrasound at the patient's bed to detect early complications of the implantation. Results Acute mechanical complications following the implantation of CIED accounted for 5.3%, of which 13 were pneumothorax (3.3%), in over 92% of cases of mild degree. The diagnosis was made by chest ultrasound alone in 10 cases (77%), in 2 cases (15.3%) by radiography alone and in 1 case (7.7%) by both methods (p-value 0.006). In 3 patients it was necessary to place a pleural drainage, in 2 cases the diagnosis was made with ultrasound alone and in 1 case with radiography alone (p=ns). Eight pericardial effusions (2%) were also observed, all of a mild degree, diagnosed exclusively with ultrasound methods and did not require drainage. No cases of hemothorax were observed. Conclusion In our experience, thoracic ultrasound performed at the patient's bed following the implantation of a CIED has a diagnostic power superior to standard chest radiography in diagnosing early mechanical complications of the procedure, without subjecting the patient to early mobilization or ionizing radiation.