Abstract:

Objective To explore the efficacy and safety of ultrasound-guided two-point pre-localization-assisted axillary vein puncture in cardiac pacemaker implantation. Methods Sixty-three patients who needed cardiac pacemaker implantation between May 2022 and December 2023 were included in the study and randomly allocated into a conventional surgery group （n = 31） and an ultrasound two-point pre-localization group （n = 32）. The conventional surgery group underwent preparation following routine surgical procedures. In the ultrasound two-point pre-localization group， preoperative ultrasound was employed to conduct a two-point localization of the axillary vein. One point was designated as the skin puncture site， and the other indicated the puncture direction. Additionally， the ultrasound probe was positioned at an angle of 30° to the skin to measure the puncture depth， thus determining the puncture site， direction， and depth. During the surgery， ultrasound was not utilized， and the puncture was carried out based on the preoperative localization. The differences in parameters such as the first-attempt puncture success rate， puncture time， number of punctures， X-ray exposure time and dose， surgical time， pacing threshold， sensitivity， and impedance were compared to evaluate the efficacy. Safety was evaluated by comparing the incidence of pneumothorax， hemothorax， arterial injury， pocket hematoma， infection， electrode dislodgement， and wear. Results There were no statistically significant differences in baseline clinical characteristics， CIED implantation indications， and device types between the two groups （P > 0.05）. When compared with the conventional surgery group， the ultrasound two-point pre-localization group exhibited a higher first-attempt puncture success rate （38.2% vs. 63.2%， P = 0.008）， a shorter puncture time ［36.0（17.5， 79.0） s vs. 20.0（9.0， 34.0） s， P = 0.004］， fewer puncture attempts ［2（1， 4） vs. 1（1， 3）， P = 0.005］， less X-ray exposure time and dose ［12.4（7.1， 20.3） min vs. 6.2（5.5， 9.4） min， P = 0.003； 60.0（24.7， 168.1） mGy vs. 29.0（16.6， 46.4） mGy， P = 0.010］. However， there was no significant difference in the total surgical time ［（149.19 ± 41.81） min vs. （131.90 ± 40.05） min， P = 0.099］. Additionally， there were no statistically significant differences in pacemaker parameters and adverse event rates between the two groups（P > 0.05） Conclusion Ultrasound-guided two-point pre-localization assisted axillary vein puncture is a safe， effective， and highly practical method in cardiac pacemaker implantation.

Key words: ultrasound pre-positioning, axillary vein, cardiac pacemaker implantation