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Clinical experience of contrast venography guided axillary vein puncture in biventricular pacing
Ngai-Yin Chan1, L Bing Liem, Ngai-Shing Mok
1Cardiology Team, Department of Medicine & Geriatrics, Princess Margaret Hospital, Princess Margaret Hospital Road, Kowloon, Hong Kong, Hong Kong. nywfchan@netvigator.com
Insights
Axillary vein puncture (AP) is a safe and effective method for biventricular pacing in heart failure patients requiring multiple leads. This technique offers a viable alternative to subclavian puncture, minimizing complications.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Biventricular pacing treats drug-refractory heart failure with ventricular dyssynchrony.
- Standard lead placement via subclavian puncture risks subclavian crush phenomenon.
- Cephalic vein cutdown may lack sufficient space for multiple leads.
Purpose of the Study:
- To evaluate the clinical experience, effectiveness, and safety of contrast venography-guided axillary vein puncture (AP) for biventricular pacing lead placement.
- To present AP as an alternative approach to overcome limitations of other venous access methods.
Main Methods:
- Axillary vein puncture (AP) guided by contrast venography was performed in 35 patients undergoing biventricular pacing or biventricular implantable cardioverter defibrillator (ICD) implantation.
- The technique aimed for placement of all three necessary leads (atrial, right ventricular, and coronary sinus).
- Patient characteristics, procedure success rates, and complications were analyzed over a 12-month follow-up period.
Main Results:
- AP was successful in 34 out of 35 patients (97.1%).
- The primary indication was heart failure (95.7%) with diverse etiologies including ischemic and dilated cardiomyopathy.
- No complications related to AP, lead placement, or contrast venography were observed during the follow-up period.
Conclusions:
- Contrast venography-guided axillary vein puncture (AP) is a highly effective and safe technique for achieving biventricular pacing.
- AP represents a promising alternative for venous access in patients requiring complex lead placements for biventricular pacing.
- This method may become the preferred approach for biventricular pacing procedures.
Background And Objectives:
Biventricular pacing is a new modality of treatment for patients with drug-refractory heart failure and ECG evidence of dyssynchronous ventricular contraction. A third lead is required to be placed in a coronary vein through the coronary sinus for left ventricular pacing, in addition to the atrial and right ventricular leads. Subclavian crush phenomenon is associated with lead placement using subclavian puncture. Cephalic venous cutdown, free of this complication, provides vascular access which is probably too small for multiple leads placement in biventricular pacing. Contrast venography guided axillary vein puncture (AP) is an alternative approach. This study reports on clinical experience of this technique in biventricular pacing.
Methods:
AP is the method of choice for biventricular pacing in Princess Margaret Hospital and Stanford University Medical Center. Patients' clinical characteristics, effectiveness and safety of the technique were analysed.
Results:
AP was performed in 35 patients, 29 male and six female with mean age 57.1 +/- 14.7 years from 1 January 2000 to 30 June 2001. Six patients had biventricular pacing alone and 29 patients had biventricular implantable cardioverter defibrillator (ICD) implanted. Twelve (34.3%) patients have ischaemic cardiomyopathy, 22 (62.9%) patients have dilated cardiomyopathy and one (2.9%) patient has hypertrophic cardiomyopathy. Six (17.1%) patients were in NYHA Class II heart failure, 21 (60.0%) patients were in Class III and eight (22.9%) patients were in Class IV. The mean EF was 23.1 +/- 7.6%. AP was attempted for placement of all three leads in all patients. AP was successful in 34 (97.1%) patients. The single failure was due to small size of the axillary vein. There were no AP, lead or contrast-related complications with a follow up of 12 months.
Conclusions:
AP is both effective and safe for biventricular pacing. It may be the method of choice in biventricular pacing.
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