Arrhythmias & electrophysiology
Ultrasound-Guided Venous Axillary Access Versus Standard Fluoroscopic Technique for Cardiac Lead Implantation: ZEROFLUOROAXI Randomized Trial
Primary resultResult — go to the resultOdds ratio 0.55 95% CI 0.31–0.99Authors' conclusion
Ultrasound-guided AVP is safer than the fluoroscopy-guided approach because it achieves the same rate of acute success while maintaining low total procedural radiation exposure.
Study context
- Population
- Patients undergoing cardiac lead implantation for pacemakers or implantable cardioverter-defibrillator (ICD)
- Participants
- 270 patients
- Comparison
- Ultrasound-guided vs fluoroscopy-guided axillary vein puncture for cardiac lead implantation
- Ultrasoundn = 136
- Standardn = 134reference
- Primary endpoint
- Composite of:
- Pneumothorax
- Hemothorax
- Inadvertent arterial puncture
- Pocket hematoma
- Pocket infection
- Lead dislodgement
- Death
- Follow-up
- 30 days after implantation
Primary result
As reported in the abstract
Odds ratio
0.55
95% CI 0.31–0.99
P = 0.034
Ultrasoundvs Standard
OR 0.55 (95% CI 0.31–0.99); P = 0.034
Further findings
Total procedural x-ray exposure
Success at first attempt
- Total procedural x-ray exposure: P = 0.002
- Success at first attempt: P = 0.375
Safety
Inadvertent axillary arterial puncture (main difference within composite outcome)
- Lower incidence of inadvertent axillary arterial puncture in the experimental group (17% vs 6%)
- P = 0.004
Original publication
Ultrasound-Guided Venous Axillary Access Versus Standard Fluoroscopic Technique for Cardiac Lead Implantation: ZEROFLUOROAXI Randomized Trial. JACC Clin Electrophysiol. Published 17 January 2024. doi:10.
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