Caudal fluoroscopic guidance for the insertion of transvenous pacing leads.
cardiac implantable electronic device insertion
caudal fluoroscopy
pneumothorax
subclavian vein puncture
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
11 Jan 2024
11 Jan 2024
Historique:
revised:
12
12
2023
received:
16
10
2023
accepted:
29
12
2023
medline:
11
1
2024
pubmed:
11
1
2024
entrez:
11
1
2024
Statut:
aheadofprint
Résumé
Pneumothorax is a well-recognized complication of cardiac implantable electronic device (CIED) insertion. While AP fluoroscopy alone is the most commonly imaging technique for subclavian or axillary access, caudal fluoroscopy (angle 40°) is routinely used at our institution. The caudal view provides additional separation of the first rib and clavicle and may reduce the risk of pneumothorax. We assessed outcomes at our institution of AP and caudal fluoroscopic guided pacing lead insertion. Retrospective cohort study of consecutive patients undergoing transvenous lead insertion for pacemakers, defibrillators, and cardiac resynchronization therapy devices between 2011 and 2023. Both de novo and lead replacement/upgrade procedures were included. Data were extracted from operative, radiology, and discharge reports. All patients underwent postprocedure chest radiography. Three thousand two hundred fifty-two patients underwent insertion of pacing leads between February 2011 and March 2023. Mean age was 71.1 years (range 16-102) and 66.7% were male. Most (n = 2536; 78.0%) procedures used caudal guidance to obtain venous access, while 716 (22.0%) procedures used AP guidance alone. Pneumothoraxes occurred in five (0.2%) patients in the caudal group and five (0.7%) patients in the AP group (p = .03). Subclavian contrast venography was performed less frequently in the caudal group (26.2% vs. 42.7%, p < .01). Caudal fluoroscopy for axillary/subclavian access is associated with a lower rate of pneumothorax and contrast venography compared with an AP approach.
Sections du résumé
BACKGROUND
BACKGROUND
Pneumothorax is a well-recognized complication of cardiac implantable electronic device (CIED) insertion. While AP fluoroscopy alone is the most commonly imaging technique for subclavian or axillary access, caudal fluoroscopy (angle 40°) is routinely used at our institution. The caudal view provides additional separation of the first rib and clavicle and may reduce the risk of pneumothorax. We assessed outcomes at our institution of AP and caudal fluoroscopic guided pacing lead insertion.
METHODS
METHODS
Retrospective cohort study of consecutive patients undergoing transvenous lead insertion for pacemakers, defibrillators, and cardiac resynchronization therapy devices between 2011 and 2023. Both de novo and lead replacement/upgrade procedures were included. Data were extracted from operative, radiology, and discharge reports. All patients underwent postprocedure chest radiography.
RESULTS
RESULTS
Three thousand two hundred fifty-two patients underwent insertion of pacing leads between February 2011 and March 2023. Mean age was 71.1 years (range 16-102) and 66.7% were male. Most (n = 2536; 78.0%) procedures used caudal guidance to obtain venous access, while 716 (22.0%) procedures used AP guidance alone. Pneumothoraxes occurred in five (0.2%) patients in the caudal group and five (0.7%) patients in the AP group (p = .03). Subclavian contrast venography was performed less frequently in the caudal group (26.2% vs. 42.7%, p < .01).
CONCLUSION
CONCLUSIONS
Caudal fluoroscopy for axillary/subclavian access is associated with a lower rate of pneumothorax and contrast venography compared with an AP approach.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
Atti V, Turagam MK, Garg J, et al. Subclavian and axillary vein access versus cephalic vein cutdown for cardiac implantable electronic device implantation. JACC: Clin Electrophysiol. 2020;6(6):661-671.
Patel HC, Hayward C, Nanayakkara S, Broughton A, Mariani JA. Caudal fluoroscopy to guide venous access for pacemaker device implantation: should this now be standard practice? Heart Asia. 2017;9(1):68-69.
Yang F, Kulbak G. A new trick to a routine procedure: taking the fear out of the axillary vein stick using the 35° caudal view. Europace. 2015;17(7):1157-1160.
Vetta G, Magnocavallo M, Parlavecchio A, et al. Axillary vein puncture versus cephalic vein cutdown for cardiac implantable electronic device implantation: a meta-analysis. Pacing Clin Electrophysiol. 2023;46(8):942-947.
Chan NY, Kwong NP, Cheong AP. Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown. Europace. 2017;19(7):1193-1197.
Ogunbayo GO, Charnigo R, Darrat Y, et al. Incidence, predictors, and outcomes associated with pneumothorax during cardiac electronic device implantation: a 16-year review in over 3.7 million patients. Heart Rhythm. 2017;14(12):1764-1770.
Littleford PO, Parsonnet V, Spector SD. Method for the rapid and atraumatic insertion of permanent endocardial pacemaker electrodes through the subclavian vein. Am J Cardiol. 1979;43(5):980-982.
Kirkfeldt RE, Johansen JB, Nohr EA, Moller M, Arnsbo P, Nielsen JC. Pneumothorax in cardiac pacing: a population-based cohort study of 28,860 Danish patients. Europace. 2012;14(8):1132-1138.
Benz AP, Vamos M, Erath JW, Hohnloser SH. Cephalic vs. subclavian lead implantation in cardiac implantable electronic devices: a systematic review and meta-analysis. EP Europace. 2019;21(1):121-129.
Hasan F, Nedios S, Karosiene Z, et al. Perioperative complications after pacemaker implantation: higher complication rates with subclavian vein puncture than with cephalic vein cutdown. J Interv Card Electrophysiol. 2023;66(4):857-863.
Maffè S, Paffoni P, Di Nardo F, et al. Ultrasound-guided axillary vein puncture for cardiac device implantation: a safe and effective approach. J Innov Cardiac Rhythm Manage. 2023;14(4):5410-5419.
Seto AH, Jolly A, Salcedo J. Ultrasound-guided venous access for pacemakers and defibrillators. J Cardiovasc Electrophysiol. 2013;24(3):370-374.
Tagliari AP, Kochi AN, Mastella B, et al. Axillary vein puncture guided by ultrasound vs cephalic vein dissection in pacemaker and defibrillator implant: a multicenter randomized clinical trial. Heart Rhythm. 2020;17(9):1554-1560.
Migliore F, Siciliano M, De Lazzari M, et al. Axillary vein puncture using fluoroscopic landmarks: a safe and effective approach for implantable cardioverter defibrillator leads. J Interv Card Electrophysiol. 2015;43(3):263-267.
Sharma G, Senguttuvan NB, Thachil A, et al. A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion. Can J Cardiol. 2012;28(5):542-546.
Antonelli D, Feldman A, Freedberg NA, Turgeman Y. Axillary vein puncture without contrast venography for pacemaker and defibrillator leads implantation. Pacing Clin Electrophysiol. 2013;36(9):1107-1110.
Squara F, Tomi J, Scarlatti D, Theodore G, Moceri P, Ferrari E. Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access. EP Europace. 2017;19(12):2001-2006.
Beig JR, Ganai BA, Alai MS, et al. Contrast venography vs. microwire assisted axillary venipuncture for cardiovascular implantable electronic device implantation. EP Europace. 2018;20(8):1318-1323.
Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-3520.
Bottinor W, Polkampally P, Jovin I. Adverse reactions to iodinated contrast media. Int J Angiol. 2013;22(3):149-154.
Thomas GR, Kumar SK, Turner S, Moussa F, Singh SM. The natural history and treatment of cardiac implantable electronic device associated pneumothorax-a 10-year single-centre experience. CJC Open. 2021;3(2):176-181.