Outcomes of Supraclavicular Access in Temporary Pacemaker Implantation

Temporary pacemaker (TPM) implantation is a critical intervention for managing symptomatic bradyarrhythmias. While infraclavicular access via subclavian or internal jugular veins is commonly used, the supraclavicular approach has emerged as a promising alternative with potential benefits in safety and procedural efficiency. However, data comparing these approaches, particularly in resource-limited settings, remain limited.

We conducted a retrospective observational study at a tertiary care center, evaluating all patients who underwent TPM implantation via either supraclavicular or infraclavicular venous access between January 2020 and December 2024. Baseline characteristics, procedural success, complications, and outcomes were compared. Multivariate logistic regression identified predictors of complications. A ROC curve and Kaplan-Meier analysis were used to evaluate model performance and complication-free survival.

Of 3569 patients, 1644 received supraclavicular access and 1925 received infraclavicular access. The supraclavicular group had a significantly lower overall complication rate (9.3% vs. 14.8%, p < 0.001), including fewer arterial punctures, pneumothoraces, lead dislodgements, and hematomas. First-attempt success (89.4% vs. 83.2%, p < 0.001) and mean procedure time (24.6 ± 7.8 min vs. 29.1 ± 9.4 min, p < 0.001) were also better with supraclavicular access. On multivariate analysis, supraclavicular access was independently associated with fewer complications (adjusted OR 0.59, p < 0.001). Kaplan-Meier analysis showed longer complication-free survival in the supraclavicular group (log-rank p = 0.01).

Supraclavicular venous access for TPM implantation is associated with fewer complications, greater procedural efficiency, and improved patient outcomes compared to infraclavicular access. Wider adoption may improve safety in high-volume or resource-limited settings.