Transthoracic echocardiography (TTE)-guided permanent pacemaker implantation without fluoroscopy was feasible in patients with adequate supine acoustic windows, according to a prospective, single-center study recently published in JACC: Advances.

Tianjie Feng, MD, et al., included 31 patients with guideline-based pacing indications and adequate supine acoustic windows to undergo TTE-only permanent pacemaker implantation. Procedural success was defined as completion without fluoroscopic conversion and achievement of TTE-defined anatomical, electrical and safety criteria.

Overall, 30 of 31 patients saw successful TTE-only implantation (96.8%; 95% CI, 83.3-99.9). Fluoroscopic conversion occurred in one patient (3.2%). There were no major acute procedural complications. Atrial lead dislodgement occurred in one of 21 dual-chamber recipients (4.8%; 95% CI, 0.1-23.8) over a median follow-up period of 8.8 months.

Mean procedure time was 55.4 ± 5.6 minutes; however, the authors noted the procedure time declined with chronological case order (–0.59 minutes/case; Newey-West 95% CI: –0.68 to –0.49).

"To our knowledge, this is the first prospective feasibility study to evaluate a standardized, fully transthoracic workflow for conventional transvenous pacemaker implantation without intraprocedural fluoroscopic guidance," write the authors. "TTE provided step-specific, two-dimensional structural visualization."