Abstract
Simple SummaryBoth cardiac implantable electronic device (CIED) implantations and electrophysiology procedures require vascular access to reach the heart through vessels. Different types of access carry different rates of complications. Safety and ease of vascular access are the main targets of physicians; in fact, each complication causes morbidity and raises costs. To avoid complications, the use of ultrasound-guided vessel puncture and closure devices is increasing in frequency. We conducted a survey in Italian centers to outline common practice; an uneven pattern of habits emerged. Hopefully, recently published scientific society consensus statements will lead to an improvement in physicians’ practice. The survey highlights that there is an unmet need for dedicated courses, particularly for ultrasound-guided vessel puncture.Cardiac implantable electronic device (CIED) implants and electrophysiological procedures share a common step: vascular access. On behalf of the AIAC Ricerca Investigators’ Network, we conducted a survey to outline Italian common practice regarding vascular access in EP-lab. All Italian physicians with experience in CIED implantation and electrophysiology were invited to answer an online questionnaire (from May 2020 to November 2020) featuring 20 questions. In total, 103 cardiologists (from 92 Italian hospitals) answered the survey. Vascular access during CIED implants was considered the most complex step following lead placement by 54 (52.4%) respondents and the most complex for 35 (33.9%). In total, 54 (52.4%) and 49 (47.6%) respondents considered the cephalic and subclavian vein the first option, respectively (intrathoracic and extrathoracic subclavian/axillary vein by 22 and 27, respectively). In total, 45 (43.7%) respondents performed close arterial femoral accesses manually; only 12 (11.7%) respondents made extensive use of vascular closure devices. A total of 46 out of 103 respondents had experience in ultrasound-guided vascular accesses, but only 10 (22%) used it for more than 50% of the accesses. In total, 81 (78.6%) respondents wanted to increase their ultrasound-guided vascular access skills. Reducing complications is a goal to reach in cardiac stimulation and electrophysiological procedures. Our survey shows the heterogeneity of the vascular approaches used in Italian centres. Some vascular accesses were proved to be superior to others in terms of complications, with ultrasound-guided puncture as an emerging technique. More effort to produce the standardization of vascular accesses could be made by scientific societies.
Highlights
Venous accesses in cardiac stimulation and in electrophysiological laboratories represents a fundamental step towards implantation safety and efficacy
The cardiologists interviewed were predominantly experienced in cardiac stimulation and 15 (15%) performed procedures in pediatric populations; in detail, 86 (84.5%) had an annual number of implants of more than 75 Cardiac implantable electronic device (CIED) (41 more than 150)
We investigated common practice regarding vascular access during electrophysiological procedures and the use of vascular closure devices
Summary
Venous accesses in cardiac stimulation and in electrophysiological laboratories represents a fundamental step towards implantation safety and efficacy. Different venous accesses are currently used for CIED implantations, but each approach presents potential advantages and disadvantages. Axillary vein access (i.e., the extrathoracic portion of the subclavian vein) has the advantages of both approaches, but it may require fluoroscopy (and venogram) or ultrasound. The risk of vascular complications is not negligible, both in terms of frequency and clinical implications. With these assumptions, the purpose of our survey was to evaluate common Italian practice concerning how vascular access maneuvers are perceived by operators and which vessels and techniques are preferentially used
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