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Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian

Ngai-Yin Chan1, Nim-Pong Kwong2, Adrian-Piers Cheong3

  • 1Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong, People's Republic of China.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|October 14, 2016
PubMed

Insights

Contrast-guided axillary vein puncture (AP) reduces long-term pacemaker lead failure compared to subclavian puncture (SP). AP also offers higher success rates than cephalic vein cutdown (CV) for venous access during pacemaker implantation.

Area of Science:

  • Cardiovascular Medicine
  • Medical Devices
  • Surgical Techniques

Background:

  • Long-term pacemaker lead failure (PLF) data regarding venous access methods are limited and conflicting.
  • Understanding optimal venous access is crucial for pacemaker longevity and patient outcomes.

Purpose of the Study:

  • To compare the incidence of PLF between contrast-guided axillary vein puncture (AP) and subclavian puncture (SP).
  • To evaluate if AP is comparable to cephalic vein cutdown (CV) regarding PLF.
  • To assess the success rates of AP, SP, and CV for venous access in pacemaker implantation.

Main Methods:

  • Retrospective review of 409 patients with 681 implanted pacemaker leads.
  • Leads were implanted via AP (252), CV (217), or SP (212).
  • Multivariate Cox regression analysis was used to identify predictors of PLF over a mean follow-up of 73.6 months.

Main Results:

  • A total of 20 (2.9%) PLF occurred.
  • PLF rates were 1.2% for AP, 2.3% for CV, and 5.6% for SP.
  • Subclavian puncture (SP) was the only independent predictor of increased PLF risk (HR 0.261, P=0.042) compared to AP.
  • Venous access success rates were significantly higher for AP (97.6%) and SP (96.8%) than for CV (78.2%).

Conclusions:

  • Axillary vein puncture (AP) independently predicts a lower risk of pacemaker lead failure (PLF) compared to subclavian puncture (SP).
  • Cephalic vein cutdown (CV) showed a higher PLF rate than AP.
  • AP and SP demonstrated similar high success rates for venous access, while CV was significantly less successful, suggesting AP as a preferred venous access for pacemaker leads.
Abstract

Keywords:
Axillary vein punctureCephalic vein cutdownLead failurePacemakerSubclavian crushSubclavian vein puncture

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