126/The use of real-time ultrasound guided venepuncture and Z suture to reduce vascular complications associated with implantation of a single chamber leadless pacemaker

Background: Leadless pacemaker therapy is associated with a significant reduction in complication rate as compared with conventional transvenous single chamber pacemaker. However, vascular access complication is around 1.2% due to large delivery femoral sheath (27Fr). We examined the importance of real-time ultrasound guidance venepuncture and Z suture to reduce total and major vascular complications.
Method: This was completed by retrospective and prospective analysis of all adverse events occurring with leadless pacemaker (Micra) implantation by two operators in a single tertiary centre from December 2016 to December 2018. All patients underwent real time ultrasound guided venepuncture for vascular access as well as Z suture to achieve haemostasis at the end of the procedure. Data was collected on implant indications, implant procedure, complication and follow up data.
Results: Forty-five patients aged 76 ± 14 years (range 24–94 years) with 21 (46.6%) of the patients being female were recruited to the study. Pacing indication includes atrial fibrillation 24 (53.3%), vascular 7 (15.5%), infection 9, (20%), cognitive/frailty 3 (6.6%) and occupational 2 (4.4%). Implants were performed under general anaesthetic for 6 (13.3%) versus local anaesthetic and sedation for 39 (86.6%). Single deployment was achieved in 43 (95.5%) versus 2 deployments in 2 (4.4%). There were no vascular or major complications reported in our cohort of patients.
Conclusions: This observational study suggests that the use of real-time ultrasound guided venepuncture and Z suture significantly reduce total and major vascular complications associated with implantation of leadless pacemaker.