ArticlePacing and clinical electrophysiology : PACE2025
Ultrasound Guided Venous Access for Cardiac Devices: Defining Learning Curve for Safety, Efficacy, and Radiation Exposure.
Article in Pacing and clinical electrophysiology : PACE, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Quantifying the Learning Curve in Ultrasound-Guided Vascular Access: Proficiency Metrics of Self-Taught Axillary Vein Puncture for CIED Implantation.Medical sciences (Basel, Switzerland) · 2026Article
- Axillary Versus Subclavian Venous Access for Permanent Pacemaker Implantation: Complications, Evolving Techniques and Practical Recommendations.Medicina (Kaunas, Lithuania) · 2025Review
- Ultrasound Guided Venous Access for Cardiac Devices: Defining Learning Curve for Safety, Efficacy, and Radiation Exposure.Pacing and clinical electrophysiology : PACE · 2025Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundThere is limited real-world experience of the learning curve for ultrasound (US) guided axillary venous access for cardiac device implantation, and it is usually performed before cutaneous incision. We investigated the learning curve, radiation exposure, safety, and efficacy of US-guided venous access in standard workflow.
methodsUS-guided access was performed by an experienced electrophysiologist with no prior application of the technique by using a standard vascular US probe and minimal modification to workflow. The learning curve was evaluated using access time (needle-to-wire time). Complications were recorded until hospital discharge, and efficacy was defined by procedural success. Radiation dose savings were estimated based on fluoroscopy time for access, and a control group underwent conventional fluoroscopy landmark-guided access (n = 44 punctures).
results147 US-guided punctures were performed in 74 patients for one (8%), two (71%), or three (17%) leads, or upgrades (4%). Access was successful in 97% (n = 72). There were no access-related peri-procedural complications. First US-guided access time was 30 seconds (interquartile range [IQR]: 17,60), and was similar to fluoroscopy-guided access time (43 seconds, IQR: 24,58; p = 0.45). Access time stabilized after 45 procedures, decreasing from 81 (IQR: 61,90) to 16 seconds (IQR: 10,20) from the first to the last 15 procedures (p < 0.001). 96% (n = 69) did not require fluoroscopy. 4% (n = 3) required 1 second fluoroscopy to confirm wire position after difficult passage. Estimated radiation exposure saving from controls was 30 seconds (IQR: 15,78) of fluoroscopy, resulting in 0.4 (IQR: 0.26,1.7) mGy cumulative skin dose, equivalent to 1.3 (95% confidence interval: 0.26,1.45) patient chest radiograph radiation exposure.
conclusionUS-guided axillary venous access for cardiac device implantation is feasible in a standard workflow and reduces radiation exposure. The learning curve time is acceptable, and the procedure is safe, even during training.
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