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Published on: December 11, 2017
Percutaneous Pacemaker Lead Implantation in Patients With Univentricular Circulation and Selected Patients With
Katarzyna Gendera1, Christof Kolb2,3, Jan Janoušek4
1Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center TUM University Hospital, Technical University of Munich Munich Germany.
Background:
Epicardial pacemaker lead implantation in patients with univentricular circulation following total cavopulmonary connection with an extracardiac conduit and without fenestration necessitates median sternotomy. Transvenous access, although possible and previously described, may be technically challenging in this population and carries an increased risk of lead-related thrombosis within the subsystemic atrium or ventricle. Surgical implantation usually requires mechanical ventilation and is associated with procedural morbidity. A percutaneous approach represents a minimally invasive treatment option that can be applied in this subgroup and in selected patients with biventricular circulation. We report on 9 patients in whom a pacemaker lead was implanted percutaneously with the use of a puncture sheath.
Methods:
Patients with pacemaker indications and anatomic constraints precluding conventional transvenous access underwent computed tomographic imaging for procedural planning. Eight patients had single-ventricle physiology, and 1 patient had biventricular circulation with severely impaired ventricular function.
Results:
Percutaneous pacemaker lead implantation was successful in all 9 patients. The median age was 11.2 (range, 6.0-43.8) years, and median weight was 22.0 (range, 19.9-68.5) kg. In 6 patients, the puncture was performed via the subxyphoidal approach, in 1 patient via the transthoracic approach, and in 2 patients, venous access was used (subclavian vein, n=1; internal jugular vein, n=1). The median follow-up time was 26.5 (range, 0.1-64.8) months. Only 1 patient required reintervention for lead dysfunction after 26 months; in all others, lead thresholds remained stable.
Conclusions:
Percutaneous intramyocardial and intracavitary pacemaker lead implantation is feasible and may obviate the need for surgery. However, in selected cases, identifying a suitable landing zone may be challenging due to prior surgical interventions, scarring, or fibrosis.
