Reducing radiation exposure and incision time in pacemakers implantation procedures using direct percutaneous axillary vein puncture

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: Radiation exposure during device implantation depends overall on the operator experience but also on the type of venous access, type of device and number of leads implanted. PURPOSE: to investigate radiation exposure/incision time for uni/bicameral pacemakers (PM) implantation procedures using direct percutaneous axillary vein puncture without primary fluoroscopy guidance and to assess the safety and the efficiency of this procedure strategy. METHODS: single center retrospective cohort study of patients implanted with unicameral and bicameral PM between January 2020 and December 2020 using direct percutaneous axillary vein puncture. All pts were given detailed explanations and informed consent. Procedural steps were: (I) direct percutaneous axillary vein puncture (anatomical landmarks: 1 or 2 cm medial and parallel to the deltopectoral groove at the level of the coracoid process); obtain separate vein access: 1 or 2 punctures; (II) skin incision and subcutaneous pocket dissection; (III) right ventricle (RV) ± right atrium (RA) lead placement and fixation. We analyzed the following data: fluoroscopy/incision time, dose area product (DAP) and the outcome related to procedure difficulties and complications. RESULTS: We collected data from 209 consecutive implant procedures; 152 patients (pts) underwent bicameral PM implantation, 57 pts received a unicameral device. All the procedures were done by the same operator (54 yo, 22 years of experience in PM implantation) using axillary access alone (2 years' experience in this technique). In 37 patients (18%) fluoroscopy guided puncture was needed. The mean fluoroscopy time was: bicameral PM 1.2±1.0 min (average incision time: 8.4±5.2 min); unicameral PM 0.4±0.3 min (average incision time: 6.5±4.3 min). The mean DAP was: bicameral PM 0.00358±0.00545 mGy/cm2; unicameral PM 0.00285±0.00449 mGy/cm2. In short term follow-up 1 patient (0.4%) developed pneumothorax and subsequent drainage was needed. Total follow-up period 19.7±4.3 months: at 6 months follow-up 1 patient (0.4%) presented lead fracture; 1 patient with DDD PM (0.4%) presented pocket infection; leads extraction were successful performed and another device was implanted. No other complications were noted. CONCLUSION: Single venous access using axillary vein puncture was associated with reduced radiation exposure and decreased incision time. Our data showed a low incidence of complications. [Figure: see text]