Comparison between thoracic ultrasound and chest x‐ray in detection of non‐infective early complications of cardiac implantable electronic devices implantation (CRUSADERS study)

Background and Aims: Chest radiography (CXR) is the gold standard tool for early mechanical complications' detection after cardiac implantable electronic devices (CIED) procedures, along with CIED electrical parameters control for the diagnosis of early catheter dislodgement. However, the detection of thoracic complications using CXR is limited, and it requires radiation exposure. Thoracic ultrasound (TUS) is a more versatile and quicker alternative for the diagnosis of thoracic pathologies, although its use in cardiac electrophysiology is not yet validated. Aim of this study was to compare the diagnostic power of CXR and TUS in the diagnosis of non-infective early complications of CIED implantation. Methods: A total of 397 patients who underwent CIED implantation were prospectively enrolled from 1 November 2021, to 30 September 2022. Following surgery, all patients underwent CXR and TUS at the patient's bed and the electrical parameters were tested before discharge. Results: 21 patients experienced mechanical complications (5.3%), of which the most common were pneumothorax (3.3%) and pericardial effusion (2%). TUS demonstrated non-inferior accuracy in diagnosing early mechanical complications, with increased sensitivity when compared to CXR. When associated with device interrogation, TUS was at least as accurate as CXR and device control in diagnosing lead dislodgment. Conclusions: TUS has a non-inferior diagnostic power compared to the CXR to detect early mechanical complications of CIED implantation, avoiding x-ray exposure. Our results suggest that TUS could be employed as a primary technique in association with standard electrical control to diagnose postoperative complications.