Authors

• Krešimir Librenjak — General Hospital Zadar, Zadar, Croatia — ORCID: 0000-0002-4168-6120
• Darija Grbić — General Hospital Zadar, Zadar, Croatia — ORCID: 0000-0002-3580-0396
• Jogen Patrk — General Hospital Zadar, Zadar, Croatia
• Nikolina Vidaković — General Hospital Zadar, Zadar, Croatia — ORCID: 0000-0002-1657-9729

Keywords

pacemaker, subclavian vein, angiography

DOI

Full Text

Implantation of permanent pacemaker is a routine procedure nowadays for treatment of bradyarrhythmia. Usually, electrodes are inserted to the right atrium, right ventricle and in case of CRT implantation to left ventricle area through coronary sinus, by the puncture of left subclavian vein. To ensure safe and successful puncture, it is desirable to do angiography of subclavian vein with its inflow into vena cava superior. ( 1 ) In some institutions it is a standard procedure. In the Cardiac Catheterization Lab of Zadar General Hospital, angiography is not performed in routine manner, but a venous path with an extension is prepared with infusion system and triangular extension for iodine contrast and venous angiography. In case of complex anatomy and difficult puncture of subclavian vein, angiography of subclavian vein is preformed to guide puncture. With this method repeated punctures are avoided and thus the risk of complications is reduced. It is important to emphasize that with the described approach, the possibility of provoking iatrogenic pneumothorax is minimalized, which is complication that extends the length of hospitalization. Also, subclavian venography itself gives us information on possible anatomic malformations or vein variations, and we can be adequately prepared for fast and successful implantation of permanent pacemakers.