Arrhythmias & electrophysiology
Feasibility and Safety of Transthoracic Echocardiography–Guided Transvenous Permanent Pacemaker Implantation Without Fluoroscopy
Authors' conclusion
In 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.
Study context
- Population
- Thirty-one selected patients (59.6%) of 52 consecutive patients screened who were referred to the Department of Structural Heart Disease, with guideline-based pacing indications and adequate prespecified supine TTE acoustic windowsselected patients (59.6%) of 52 consecutive patients screened who underwent attempted TTE-only implantation
- Participants
- 31 participants
Main finding
As reported in the abstract
Acute procedural success (TTE-only implantation successful)
TTE-only implantation
96.8%
30/31 of 31
- 95% CI
- 83.3-99.9
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| Fluoroscopic conversion | TTE-only implantation 3.2% |
| Procedure time | TTE-only implantation mean 55.4 ± 5.6 minutes |
Procedure time by chronological case order
- Change in procedure time per case
- −0.59 minutes/case
- Newey-West 95% CI
- −0.68 to −0.49
- Exploratory team-level association
Safety
| Outcome | Values |
|---|---|
| Atrial lead dislodgement requiring revision (dual-chamber recipients) · median follow-up of 8.8 months (IQR: 6-12 months) | TTE-only implantation 4.8% |
- Atrial lead dislodgement requiring revision (dual-chamber recipients) — 95% CI
- 0.1-23.8
- Atrial lead dislodgement requiring revision (dual-chamber recipients): of 21 dual-chamber recipients
Major acute procedural complications
- No major acute procedural complications occurred
Original publication
Feasibility and Safety of Transthoracic Echocardiography–Guided Transvenous Permanent Pacemaker Implantation Without Fluoroscopy. JACC Adv. Published 5 October 2026. doi:10.
Summarised from the published abstract; every number is checked against it