Cephalic cut-down as preferred approach for dual chamber pacemaker implantation

    Authors

    Abstract

    **Introduction:** Literature suggests that cephalic approach is more beneficial than subclavian access in preventing complications when performing cardiac implantable electronic devices (CIED) implantation. In recent survey by European Heart Rhythm Association (EHRA) cephalic vein as venous access for lead implantation was the preferred approach in 60% of the centres (1). In University Hospital Centre Split, we prefer cephalic cut - down as first choice for venous approach in single and dual chamber pacemaker implantation. The aim of study was to analyze the success rate of cephalic cut - down in dual chamber pacemaker implantation. **Methods and Results:** We retrospectively analyzed data regarding dual pacemaker chamber implantation from January 2016 to October 2018. During that period 194 dual chamber pacemakers were implanted. Cephalic vein access was achieved by dissection and direct visualization. When needed, to facilitate entry into cephalic vein we used hydrophilic guidewire and/or introducer sheath. In 118 cases (61%) both leads were inserted using cephalic access exclusively. One lead by cephalic cut down and another by subclavian venipuncture was performed in 34 (18%) cases. In 42 (21%) implantations subclavian venipuncture was required for implantation of both leads. **Conclusion**: Our results are in concordance from data of EHRA survey. Use of refinements of the cut-down cephalic approach might obviate puncture of subclavian/axillary veins in majority of cases.

    Keywords

    implantable cardiac electronic devices, cephalic approach, complications

    DOI

    https://doi.org/10.15836/ccar2018.332

    Literature

    1. Parsonnet V, Roelke M. The cephalic vein cutdown versus subclavian puncture for pacemaker/ICD lead implantation. Pacing Clin Electrophysiol. 1999 May;22(5):695–7. https://doi.org/10.1111/j.1540-8159.1999.tb00531.x
    Cardiologia Croatica
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    Cephalic cut-down as preferred approach for dual chamber pacemaker implantation

    Extended Abstract
    Issue11-12
    Published
    Pages332
    PDF via DOIhttps://doi.org/10.15836/ccar2018.332
    implantable cardiac electronic devices
    cephalic approach
    complications

    Authors

    Josip Kedžo*ORCIDKlinički bolnički centar Split, Split, Hrvatska
    Zrinka JurišićORCIDKlinički bolnički centar Split, Split, Hrvatska
    Toni BreškovićORCIDKlinički bolnički centar Split, Split, Hrvatska
    Marina Jurić PaićORCIDKlinički bolnički centar Split, Split, Hrvatska
    Ivan PletikosićORCIDKlinički bolnički centar Split, Split, Hrvatska

    *Correspondence email: j.kedzo@gmail.com

    Abstract

    **Introduction:** Literature suggests that cephalic approach is more beneficial than subclavian access in preventing complications when performing cardiac implantable electronic devices (CIED) implantation. In recent survey by European Heart Rhythm Association (EHRA) cephalic vein as venous access for lead implantation was the preferred approach in 60% of the centres (1). In University Hospital Centre Split, we prefer cephalic cut - down as first choice for venous approach in single and dual chamber pacemaker implantation. The aim of study was to analyze the success rate of cephalic cut - down in dual chamber pacemaker implantation. **Methods and Results:** We retrospectively analyzed data regarding dual pacemaker chamber implantation from January 2016 to October 2018. During that period 194 dual chamber pacemakers were implanted. Cephalic vein access was achieved by dissection and direct visualization. When needed, to facilitate entry into cephalic vein we used hydrophilic guidewire and/or introducer sheath. In 118 cases (61%) both leads were inserted using cephalic access exclusively. One lead by cephalic cut down and another by subclavian venipuncture was performed in 34 (18%) cases. In 42 (21%) implantations subclavian venipuncture was required for implantation of both leads. **Conclusion**: Our results are in concordance from data of EHRA survey. Use of refinements of the cut-down cephalic approach might obviate puncture of subclavian/axillary veins in majority of cases.

    Literature

    1. 1.
      Parsonnet V, Roelke M. The cephalic vein cutdown versus subclavian puncture for pacemaker/ICD lead implantation. Pacing Clin Electrophysiol. 1999 May;22(5):695–7.DOI