Related Experiment Video
Updated: Jun 6, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Safety and feasibility of cephalic venous access for cardiac resynchronization device implantation
Bassey Ussen1, Paramdeep S Dhillon, Lisa Anderson
1Department of Cardiology, St. George's Hospital, London, UK.
Insights
Cephalic vein access is a safe and effective alternative for cardiac resynchronization therapy (CRT) device implantation, offering reduced procedure times and radiation exposure compared to traditional subclavian access.
Area of Science:
- Cardiology
- Medical Devices
- Vascular Access
Background:
- Subclavian vein access for cardiac resynchronization therapy (CRT) implantation carries a risk of pneumothorax.
- Evaluating alternative venous access methods is crucial for improving CRT procedural safety and efficiency.
Purpose of the Study:
- To assess the efficacy and safety of cephalic venous access as an alternative to subclavian vein access for CRT device implantation.
- To compare procedural outcomes, including success rates, duration, and complications, between cephalic and subclavian access methods.
Main Methods:
- Retrospective analysis of 103 consecutive CRT implantation procedures over a 1-year period.
- Comparison of primary success rates, procedure duration, screening times, radiation exposure, and complication rates between cephalic and subclavian venous access groups.
Main Results:
- Cephalic access alone was successful in 89% of attempted CRT implantations.
- The cephalic group demonstrated significantly shorter procedure durations (118 vs. 147 minutes) and reduced radiation exposure (4.7 vs. 9.3 Gcm(2)) compared to the subclavian group.
- Complication rates were low and comparable between the two groups (3.3% for cephalic vs. 7.1% for subclavian).
Conclusions:
- Cephalic venous access is a viable and efficient alternative for the majority of cardiac resynchronization therapy device implantations.
- This approach offers significant advantages in terms of reduced procedure time and radiation exposure, with comparable safety to subclavian access.
Background:
Cardiac resynchronization therapy (CRT) devices are usually implanted using subclavian vein access, which is associated with the risk of pneumothorax. We examined whether cephalic venous access is an effective alternative to subclavian access by the Seldinger technique for CRT delivery.
Methods:
We retrospectively analyzed all CRT procedures performed over a 1-year period at our center with respect to the access methods, primary success rate, safety, and efficiency.
Results:
We retrospectively analyzed 103 consecutive primary implantation procedures. The procedure was accomplished using cephalic access alone for 54 of 61 (89%) CRT implants attempted by this route. The overall success rate was 100% (61/61) with additional use of subclavian access. CRT implantation via subclavian vein access was successful in 37 of 42 (88%) (P < 0.05 vs cephalic group). The procedure duration was shorter for the cephalic group (118 ± 39 vs 147 ± 36 minutes, P < 0.0005) as were the screening times and radiation exposure (15 ± 9 vs 27 ± 18 minutes and 4.7 ± 5.8 vs 9.3 ± 9.1 Gcm(2) , both P < 0.01). In the cephalic group, procedure duration and radiation exposure diminished significantly with increasing experience of the technique. Complications occurred in two of 61 (3.3%) cases in the cephalic group and three of 42 (7.1%) in the subclavian group (P = NS).
Conclusion:
CRT devices can be implanted using cephalic access alone in a large majority of cases. This approach is safe and efficient.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:21Cardiac Catheterization II: Right Heart Catheterization
01:24Cardiac Catheterization III: Left Heart Catheterization
01:26Cardiac Catheterization IV: Nursing Management