ABSTRACT
PURPOSE: Ultrasound (US)-guided access for venous catheter placement has previously been shown to improve success rates and decrease access-related complications. The purpose of this study was to determine the feasibility of US-guided versus traditional vascular access approaches during implantation of cardiac implantable electronic devices (CIEDs). METHODS: We evaluated outcomes for 816 consecutive patients undergoing new CIED implantation between May 2013 and April 2016 at a single institution with respect to use of US guidance for vascular access (137 with US guidance versus 679 with traditional access techniques). The primary outcome was a composite of procedural complications including deep vein thrombosis, pneumothorax, or hematoma. RESULTS: There was no cross-over between US guidance and traditional access. The overall complication rate was 3.6% (2.2% in US, 3.8% in non-US). The use of US was associated with a decrease in fluoroscopy time (r = -0.17, p < 0.01) but not the primary outcome (r = 0.03, p = 0.34). In models adjusted for age and number of leads, use of US was non-significantly associated with a change in fluoroscopy time (beta = -0.20, p = 0.7). In logistic models adjusted for age and number of leads, use of US was associated with a trend toward reduced major complications (OR = 0.57, 95% CI 0.17-1.91, p = 0.36). CONCLUSIONS: US-guided vascular access for CIED implantation is safe and effective compared to traditional approaches with a non-significant reduction in both fluoroscopy time and procedural complications.
Subject(s)
Catheterization, Central Venous/methods , Defibrillators, Implantable/statistics & numerical data , Pacemaker, Artificial/statistics & numerical data , Ultrasonography, Interventional/methods , Aged , Aged, 80 and over , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Safety , Prosthesis Implantation , Reference Values , Retrospective Studies , Vascular Access DevicesABSTRACT
The cardiac sodium current underlies excitability in heart, and inherited abnormalities of the proteins regulating and conducting this current cause inherited arrhythmia syndromes. This review focuses on inherited mutations in non-pore forming proteins of sodium channel complexes that cause cardiac arrhythmia, and the deduced mechanisms by which they affect function and dysfunction of the cardiac sodium current. Defining the structure and function of these complexes and how they are regulated will contribute to understanding the possible roles for this complex in normal and abnormal physiology and homeostasis. This article is part of a Special Issue entitled "Na(+) Regulation in Cardiac Myocytes".
