ArticleJACC. Advances2026
Feasibility and Safety of Transthoracic Echocardiography-Guided Transvenous Permanent Pacemaker Implantation Without Fluoroscopy.
Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07458724 (Feasibility and Safety of Transthoracic Echocardiography-Guided Permanent Pacemaker Implantation Without Fluoroscopy), which is not on this map. Not yet cited in PubMed.
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Feasibility and Safety of Transthoracic Echocardiography-Guided Permanent Pacemaker Implantation Without Fluoroscopy
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7 authors.
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Abstract
backgroundFluoroscopy is routinely used for transvenous permanent pacemaker implantation, but a standardized transthoracic echocardiography (TTE)-only workflow has not been prospectively evaluated.
objectivesThe objective of the study was to evaluate the feasibility, acute safety, and procedural performance of fluoroscopy-free transvenous pacemaker implantation guided exclusively by TTE.
methodsIn this prospective, single-center feasibility study (RADIANCE [Radiation-free Anatomical Direct Imaging Approach for No-fluoroscopy Cardiac Electrode Implantation]; NCT07458724), 52 consecutive patients referred to the Department of Structural Heart Disease were screened. Thirty-one selected patients (59.6%) with guideline-based pacing indications and adequate prespecified supine TTE acoustic windows underwent attempted TTE-only implantation. Acute procedural success required completion without fluoroscopic conversion and fulfillment of prespecified TTE-defined anatomical, electrical, and safety criteria.
resultsTTE-only implantation was successful in 30/31 patients (96.8%; 95% CI: 83.3-99.9), with fluoroscopic conversion in 1/31 (3.2%). The mean procedure time was 55.4 ± 5.6 minutes. No major acute procedural complications occurred. During a median follow-up of 8.8 months (IQR: 6-12 months), atrial lead dislodgement requiring revision occurred in 1/21 dual-chamber recipients (4.8%; 95% CI: 0.1-23.8). Procedure time decreased with chronological case order (-0.59 minutes/case; Newey-West 95% CI: -0.68 to -0.49), an exploratory team-level association.
conclusionsIn selected patients with adequate supine acoustic windows, TTE-guided fluoroscopy-free pacemaker implantation was feasible with acceptable acute outcomes. The lead-position findings and exploratory case-order association require further validation in larger and more diverse populations.
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