How to Perform Extrathoracic Venous Access for Cardiac Implantable Electronic Devices Placement: Detailed Description of Techniques

Ultrasound-Guided Axillary Vein Puncture for Cardiac Device Implantation: A Systematic Review and Meta-Analysis

Ultrasound-guided axillary vein puncture (US-AVP) has recently emerged as a valid alternative to standard vein puncture (SVP) for cardiac implantable electronic device implantation. This meta-analysis aimed to compare the efficacy and safety of US-AVP versus SVP. A comprehensive search of PubMed, Embase, and Cochrane databases identified randomized clinical trials and nonrandomized clinical trials comparing these techniques. Pooled relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models, and trial sequential analysis was conducted to assess the robustness of findings. Twelve studies met the inclusion criteria, including 3085 patients (1227 in the US-AVP group and 1858 in the SVP group). US-AVP significantly reduced total complication rates compared with SVP [RR, 0.65 (95% CI, 0.48-0.89); P = 0.006; I² = 0%], with no significant difference in success rates [RR, 1.05 (95% CI, 0.99-1.11); P = 0.137; I² = 60%]. Fluoroscopy duration was significantly shorter in the US-AVP group [MD, -1.58 min (95% CI, -2.16 to -0.99); P < 0.001; I² = 81%], and X-ray exposure was markedly lower [MD, -3.23 mGy·cm² (95% CI, -6.03 to -0.43); P = 0.024; I² = 93%]. The trial sequential analysis supported the robustness of the evidence for reduced complications. In conclusion, US-AVP demonstrated a safety advantage over SVP by reducing complications while achieving comparable efficacy.

Long-Term Complications Related to Cardiac Implantable Electronic Devices

Cardiac implantable electronic devices (CIEDs) are commonly used for a number of cardiac-related conditions, and it is estimated that over 300,000 CIEDs are placed annually in the US. With advances in technology surrounding these devices and expanding indications, CIEDs can remain implanted in patients for long periods of time. Although the safety profile of these devices has improved over time, both the incidence and prevalence of long-term complications are expected to increase. This review highlights pertinent long-term complications of CIEDs, including lead-related issues, device-related arrhythmias, inappropriate device therapies, and device-related infections. We also explore key clinical aspects of each complication, including common presentations, patient-specific and non-modifiable risk factors, diagnostic evaluation, and recommended management strategies. Our goal is to help spread awareness of CIED-related complications and to empower physicians to manage them effectively.