{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:09:52Z","timestamp":1784538592702,"version":"3.55.0"},"reference-count":41,"publisher":"Elsevier BV","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","heartrhythmopen.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Heart Rhythm O2"],"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1016\/j.hroo.2026.02.004","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T22:13:20Z","timestamp":1776204800000},"page":"1374-1386","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-guided axillary access outperforms subclavian puncture for cardiac implantable electronic device implantation: A network meta-analysis of 130,831 patients"],"prefix":"10.1016","volume":"7","author":[{"given":"Maria Eduarda Marquez","family":"Almeida","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella Rodrigues","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles Karel","family":"Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Alves","family":"Barbosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Clara","family":"Miranda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1751-5206","authenticated-orcid":false,"given":"Ant\u00f4nio","family":"da Silva Menezes J\u00fanior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.hroo.2026.02.004_bib1","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad123","article-title":"2023 HRS\/EHRA\/APHRS\/LAHRS expert consensus statement on practical management of the remote device clinic","volume":"25","author":"Ferrick","year":"2023","journal-title":"Europace"},{"key":"10.1016\/j.hroo.2026.02.004_bib2","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.jacc.2024.11.023","article-title":"ACC\/AHA\/ASE\/HFSA\/HRS\/SCAI\/SCCT\/SCMR 2025 appropriate use criteria for implantable cardioverter-defibrillators, cardiac resynchronization therapy, and pacing","volume":"85","author":"Russo","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib3","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/j.1540-8159.2011.03150.x","article-title":"The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009 -- a world society of arrhythmia\u2019s project","volume":"34","author":"Mond","year":"2011","journal-title":"Pacing Clin Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib4","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.jacep.2020.01.006","article-title":"Subclavian and axillary vein access versus cephalic vein cut down for cardiac implantable electronic device implantation: a meta-analysis","volume":"6","author":"Atti","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib5","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1093\/europace\/eut345","article-title":"Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey","volume":"15","author":"Bongiorni","year":"2013","journal-title":"Europace"},{"key":"10.1016\/j.hroo.2026.02.004_bib6","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1007\/s00392-025-02692-7","article-title":"Implementation of transcutaneous ultrasound-guided axillary vein access for implantations, revisions and upgrades of cardiac implantable electronic devices in a large tertiary care center","volume":"115","author":"Nikorowitsch","year":"2026","journal-title":"Clin Res Cardiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib7","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s10840-018-0313-7","article-title":"Efficacy of ultrasound-guided axillary\/subclavian venous approaches for pacemaker and defibrillator lead implantation: a randomized study","volume":"51","author":"Liccardo","year":"2018","journal-title":"J Interv Card Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib8","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1093\/europace\/eus054","article-title":"Pneumothorax in cardiac pacing: a population-based cohort study of 28, 860 Danish patients","volume":"14","author":"Kirkfeldt","year":"2012","journal-title":"Europace"},{"key":"10.1016\/j.hroo.2026.02.004_bib9","first-page":"1193","article-title":"Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown","volume":"19","author":"Chan","year":"2017","journal-title":"Europace"},{"key":"10.1016\/j.hroo.2026.02.004_bib10","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.3390\/jcm13041044","article-title":"Cephalic vein cutdown is superior to subclavian puncture as venous access for patients with cardiac implantable devices after long-term follow-up","volume":"13","author":"Knorr","year":"2024","journal-title":"J Clin Med"},{"key":"10.1016\/j.hroo.2026.02.004_bib11","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1093\/europace\/euaa367","volume":"23","author":"Burri","year":"2021","journal-title":"Europace"},{"key":"10.1016\/j.hroo.2026.02.004_bib12","doi-asserted-by":"crossref","DOI":"10.1002\/clc.24327","article-title":"Safety and efficiency of cephalic vein puncture by modified Seldinger technique compared to subclavian vein puncture for cardiac implantable electronic devices","volume":"47","author":"Weidauer","year":"2024","journal-title":"Clin Cardiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib13","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s10840-022-01135-x","article-title":"Perioperative complications after pacemaker implantation: higher complication rates with subclavian vein puncture than with cephalic vein cutdown","volume":"66","author":"Hasan","year":"2023","journal-title":"J Interv Card Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib14","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1046\/j.1460-9592.2001.00456.x","article-title":"Prospective randomized comparison of the safety and effectiveness of placement of endocardial pacemaker and defibrillator leads using the extrathoracic subclavian vein guided by contrast venography versus the cephalic approach","volume":"24","author":"Calkins","year":"2001","journal-title":"Pacing Clin Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib15","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s42444-024-00125-6","article-title":"Feasibility of ultrasound-guided axillary vein access for implantation of cardiac implantable electronic device leads","volume":"25","author":"Oh","year":"2024","journal-title":"Int J Arrhythm"},{"key":"10.1016\/j.hroo.2026.02.004_bib16","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1016\/j.hrthm.2020.04.030","article-title":"Axillary vein puncture guided by ultrasound vs cephalic vein dissection in pacemaker and defibrillator implant: a multicenter randomized clinical trial","volume":"17","author":"Tagliari","year":"2020","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hroo.2026.02.004_bib17","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/pace.15107","article-title":"Ultrasound-guided axillary vein puncture versus landmark-guided approach for cardiac implantable electronic device placement","volume":"48","author":"Perna","year":"2025","journal-title":"Pacing Clin Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib18","first-page":"542","article-title":"A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion","volume":"28","author":"Sharma","year":"2012","journal-title":"Can J Cardiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib19","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.3390\/jpm14111084","article-title":"Ultrasound-guided axillary access using a micropuncture needle versus conventional cephalic venous access for implantation of cardiac devices: a single-center randomized trial","volume":"14","author":"Leventopoulos","year":"2024","journal-title":"J Pers Med"},{"key":"10.1016\/j.hroo.2026.02.004_bib20","doi-asserted-by":"crossref","first-page":"258","DOI":"10.31083\/j.rcm2308258","article-title":"The use of a handheld ultrasound device to guide the axillary vein access during pacemaker and cardioverter-defibrillator implantation: a feasibility study","volume":"23","author":"Sassone","year":"2022","journal-title":"Rev Cardiovasc Med"},{"key":"10.1016\/j.hroo.2026.02.004_bib21","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1111\/pace.13940","article-title":"Axillary vein access for permanent pacemaker and implantable cardioverter defibrillator implantation: fluoroscopy compared to ultrasound","volume":"43","author":"Migliore","year":"2020","journal-title":"Pacing Clin Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib22","series-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2020"},{"key":"10.1016\/j.hroo.2026.02.004_bib23","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"10.1016\/j.hroo.2026.02.004_bib24","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"10.1016\/j.hroo.2026.02.004_bib25","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1136\/ebmental-2019-300117","article-title":"How to perform a meta-analysis with R: a practical tutorial","volume":"22","author":"Balduzzi","year":"2019","journal-title":"Evid Based Ment Health"},{"key":"10.1016\/j.hroo.2026.02.004_bib26","series-title":"Doing Meta-analysis With R","author":"Harrer","year":"2021"},{"key":"10.1016\/j.hroo.2026.02.004_bib27","first-page":"63","article-title":"Trial sequential analysis","volume":"11","author":"Yang","year":"2023","journal-title":"Southwest Respir Crit Care Chronicles"},{"key":"10.1016\/j.hroo.2026.02.004_bib28","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"10.1016\/j.hroo.2026.02.004_bib29","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.recesp.2023.02.011","article-title":"Ultrasound versus fluoroscopy-guided axillary vein access for cardiac device implantation","volume":"76","author":"Bun","year":"2023","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"10.1016\/j.hroo.2026.02.004_bib30","doi-asserted-by":"crossref","first-page":"86","DOI":"10.4103\/IJCA.IJCA_10_19","article-title":"A safe and rapid technique for pacemaker implantation: roadmap-guided subclavian vein puncture","volume":"5","author":"Gunes","year":"2019","journal-title":"Int J Cardiovasc Acad"},{"key":"10.1016\/j.hroo.2026.02.004_bib31","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1111\/jce.14060","article-title":"Fluoroscopy-guided axillary vein access vs cephalic vein access in pacemaker and defibrillator implantation: randomized clinical trial of efficacy and safety","volume":"30","author":"Jim\u00e9nez-D\u00edaz","year":"2019","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib32","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1253\/circj.CJ-13-0884","article-title":"Comparison of the axillary venous approach and subclavian venous approach for efficacy of permanent pacemaker implantation. 8-Year follow-up results","volume":"78","author":"Kim","year":"2014","journal-title":"Circ J"},{"key":"10.1016\/j.hroo.2026.02.004_bib33","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1067\/mhj.2001.111261","article-title":"Lead- and device-related complications in the antiarrhythmics versus Implantable Defibrillators Trial","volume":"141","author":"Kron","year":"2001","journal-title":"Am Heart J"},{"key":"10.1016\/j.hroo.2026.02.004_bib34","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.4103\/0366-6999.193462","article-title":"Optimized axillary vein technique versus subclavian vein technique in cardiovascular implantable electronic device implantation: a randomized controlled study","volume":"129","author":"Liu","year":"2016","journal-title":"Chin Med J (Engl)"},{"key":"10.1016\/j.hroo.2026.02.004_bib35","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1093\/europace\/euw363","article-title":"Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access","volume":"19","author":"Squara","year":"2017","journal-title":"Europace"},{"key":"10.1016\/j.hroo.2026.02.004_bib36","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/j.1540-8159.2010.02975.x","article-title":"Safety and feasibility of cephalic venous access for cardiac resynchronization device implantation","volume":"34","author":"Ussen","year":"2011","journal-title":"Pacing Clin Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib37","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-018-35994-0","article-title":"Triple lead cephalic versus subclavian vein approach in cardiac resynchronization therapy device implantation","volume":"8","author":"Vogler","year":"2018","journal-title":"Sci Rep"},{"key":"10.1016\/j.hroo.2026.02.004_bib38","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1002\/joa3.12107","article-title":"Long-term reliability of the defibrillator lead inserted by the extrathoracic subclavian puncture","volume":"34","author":"Watanabe","year":"2018","journal-title":"J Arrhythm"},{"key":"10.1016\/j.hroo.2026.02.004_bib39","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.jacep.2023.11.020","article-title":"Ultrasound-guided venous axillary access versus standard fluoroscopic technique for cardiac lead implantation: ZEROFLUOROAXI Randomized Trial","volume":"10","author":"Vitali","year":"2024","journal-title":"JACC Clin Electrophysiol"},{"key":"10.1016\/j.hroo.2026.02.004_bib40","doi-asserted-by":"crossref","first-page":"4847","DOI":"10.1093\/eurheartj\/ehad629","article-title":"Intra-pocket ultrasound-guided axillary vein puncture vs. cephalic vein cutdown for cardiac electronic device implantation: the ACCESS trial","volume":"44","author":"Charles","year":"2023","journal-title":"Eur Heart J"},{"key":"10.1016\/j.hroo.2026.02.004_bib41","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1093\/europace\/euad043","article-title":"EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)","volume":"25","author":"Burri","year":"2023","journal-title":"Europace"}],"container-title":["Heart Rhythm O2"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666501826000590?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666501826000590?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:59:06Z","timestamp":1784537946000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2666501826000590"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":41,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["S2666501826000590"],"URL":"https:\/\/doi.org\/10.1016\/j.hroo.2026.02.004","relation":{},"ISSN":["2666-5018"],"issn-type":[{"value":"2666-5018","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Ultrasound-guided axillary access outperforms subclavian puncture for cardiac implantable electronic device implantation: A network meta-analysis of 130,831 patients","name":"articletitle","label":"Article Title"},{"value":"Heart Rhythm O2","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.hroo.2026.02.004","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Heart Rhythm Society. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}