Ultrasound-guided versus fluoroscopy-guided axillary vein puncture for cardiac implantable electronic device implantation: a meta-analysis enrolling 1257 patients.

IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Giampaolo Vetta, Antonio Parlavecchio, Jennifer Wright, Michele Magnocavallo, Lorenzo Marcon, Ioannis Doundoulakis, Roberto Scacciavillani, Antonio Sorgente, Luigi Pannone, Alexandre Almorad, Juan Sieira, Charles Audiat, Kazutaka Nakasone, Gezim Bala, Erwin Ströker, Ingrid Overeinder, Pietro Rossi, Andrea Sarkozy, Gian-Battista Chierchia, Carlo de Asmundis, Domenico Giovanni Della Rocca
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引用次数: 0

Abstract

Introduction: Ultrasound-guided (Echo-AVP) and Fluoroscopy-guided Axillary Vein Puncture (Fluoro-AVP) are both acknowledged as safe and effective techniques for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of Echo-AVP versus Fluoro-AVP for CIEDs implantation.

Methods: We systematically searched Medline, Embase and Cochrane electronic databases up to May 15th, 2024, for studies that evaluated the efficacy and safety of Echo-AVP and Fluoro-AVP reporting at least one clinical outcome of interest. The primary efficacy endpoint was acute procedural success and the primary safety endpoint was a composite endpoint of pneumothorax, pocket hematoma/bleeding, pocket infection and inadvertent arterial puncture. The effect size was estimated using a random-effect model as Odds Ratio (OR) and Mean Difference (MD) with relative 95% Confidence Interval (CI).

Results: Overall, 4 studies were included, which enrolled 1257 patients (Echo-AVP: 373 patients; Fluoro-AVP: 884 patients). Echo-AVP led to a significant reduction in the primary safety endpoint (OR: 0.41; p = 0.0009), risk of inadvertent arterial puncture (OR: 0.29; p = 0.003) and fluoroscopy time ( MD: -105.02; p = 0.008). No differences were found between Echo-AVP and Fluoro-AVP for acute procedural success (OR: 0.77; p = 0.27), pneumothorax (OR: 0.66; p = 0.60), pocket hematoma/bleeding (OR: 0.68; p = 0.30), pocket infection (OR: 0.66; p = 0.60), procedural time (MD: 1.99; p = 0.65), success rate at first attempt (OR: 1.25; p = 0.34) and venous access time (MD: -0. 25; p = 0.99).

Conclusion: Echo-AVP proved to reduce significantly the primary safety endpoint, inadvertent arterial puncture and fluoroscopy time compared to Fluoro-AVP.

在超声波引导下与荧光镜引导下进行腋静脉穿刺以植入心脏植入式电子装置:一项纳入 1257 例患者的荟萃分析。
导言:超声引导下的腋静脉穿刺(Echo-AVP)和透视引导下的腋静脉穿刺(Fluoro-AVP)都是公认的安全有效的经静脉植入心脏植入式电子设备(CIED)导联的技术。然而,这两种技术中哪种技术的安全性和有效性更好仍存在争议。因此,我们进行了一项荟萃分析,以评估回声-AVP 与荧光-AVP 用于 CIEDs 植入的有效性和安全性:我们系统地检索了Medline、Embase和Cochrane电子数据库(截至2024年5月15日)中对回声-AVP和荧光-AVP的有效性和安全性进行评估的研究,这些研究至少报告了一项相关的临床结果。主要疗效终点是急性手术成功率,主要安全性终点是气胸、腔袋血肿/出血、腔袋感染和意外动脉穿刺的复合终点。效应大小采用随机效应模型估算,即:比值比(OR)和平均差(MD),以及相对的95%置信区间(CI):共纳入了 4 项研究,1257 名患者参与了研究(回声-AVP:373 名患者;荧光-AVP:884 名患者)。Echo-AVP 显著降低了主要安全终点(OR:0.41;p = 0.0009)、意外动脉穿刺风险(OR:0.29;p = 0.003)和透视时间(MD:-105.02;p = 0.008)。在急性手术成功率(OR:0.77;p = 0.27)、气胸(OR:0.66;p = 0.60)、术袋血肿/出血(OR:0.68;p = 0.30)、袋内感染(OR:0.66;P = 0.60)、手术时间(MD:1.99;P = 0.65)、首次尝试成功率(OR:1.25;P = 0.34)和静脉通路时间(MD:-0.25;P = 0.99):结论:事实证明,与氟AVP相比,回声AVP能显著减少主要安全终点、意外动脉穿刺和透视时间。
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来源期刊
CiteScore
4.30
自引率
11.10%
发文量
320
审稿时长
4-8 weeks
期刊介绍: The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.
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