Implantation of cardiac resynchronization therapy devices using three leads by cephalic vein dissection approach
Alexios Hadjis1, Riccardo Proietti2, Vidal Essebag1,3
1McGill University Health Centre, 1650 Cedar Avenue, Room E5-200, Montreal, Quebec H3G 1A4, Canada.
Insights
A novel technique for implanting three leads via the cephalic vein for cardiac resynchronization therapy (CRT) devices proved safe and effective. This approach achieved high success rates with minimal complications in de novo CRT pacemaker and defibrillator implantations.
Area of Science:
- Cardiology
- Medical Devices
- Minimally Invasive Surgery
Background:
- Standard approaches for cardiac resynchronization therapy (CRT) device lead implantation are not established.
- Percutaneous subclavian, axillary, and cephalic veins are commonly used for lead placement.
Purpose of the Study:
- To describe an effective and safe technique for implanting three leads via the cephalic vein for CRT device implantation.
- To evaluate the procedural success and complication rates of this technique.
Main Methods:
- A total of 171 consecutive patients undergoing de novo CRT pacemaker or defibrillator implantation were included.
- Cephalic vein access was obtained via dissection and direct visualization.
- Procedural success and complication rates were recorded.
Main Results:
- Successful implantation of all three leads on the first attempt was achieved in 98.8% of patients.
- 150 patients (87.7%) had all three leads placed via the cephalic vein.
- Overall complications occurred in 3.5% of patients, with no cases of pneumothorax or infection.
Conclusions:
- The triple lead via cephalic vein technique is a safe and effective first-line approach for CRT device implantation.
- This method offers a high success rate and a low complication profile.
Aims:
Percutaneous subclavian, axillary, and cephalic vein access are all used in conjunction for atrial and ventricular lead implantation, though no standard approach for cardiac resynchronization therapy (CRT) device implantation has been established. We describe an effective and a safe technique for implanting three leads via cephalic vein for CRT pacemaker and/or defibrillator implantations.
Methods And Results:
A total of 171 consecutive patients undergoing de novo implantation of CRT pacemaker or defibrillator were included. Cephalic vein access was achieved by dissection and direct visualization. If the cephalic vein was inadequate, alternate means of access was determined after outset of the procedure. Procedural success rates and complications were recorded. Of the 171 de novo CRT implant attempts, 169 (98.8%) patients had successful implantation of all 3 leads on the first attempt. Of the 171 procedural attempts, 150 (87.7%) patients had all 3 leads placed via cephalic vein. Overall, complications occurred in 6 of 171 patients (3.5%) including initial and repeat procedures. These complications included seven lead dislodgements, two cases of diaphragmatic stimulation requiring lead revision, and one coronary sinus dissection without pericardial effusion. There were no cases of pneumothorax, pocket haematoma requiring evacuation, or infection.
Conclusion:
The triple lead via cephalic vein technique is safe and effective when used as a first approach for CRT device implantation.
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