A Comparison of Lead Placement Through the Subclavian Vein Technique With Fluoroscopy-Guided Axillary Vein Technique for Permanent Pacemaker Insertion

Abstract Background The intrathoracic subclavian venous technique for pacemaker implantation may be associated with serious complications. We describe an alternative technique for obtaining venous access for pacemaker implantation through axillary vein under fluoroscopic guidance and compare it with...

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Bibliographic Details
Published in:Canadian journal of cardiology 2012-09, Vol.28 (5), p.542-546
Main Authors: Sharma, Gautam, MD, DM, Senguttuvan, Nagendra Boopathy, MD, DM, Thachil, Ajit, MD, DM, Leong, Darryl, MBBS, FRACP, Naik, Nitish, MD, DM, Yadav, Rakesh, MD, DM, Juneja, Rajnish, MD, DM, Bahl, Vinay K., MD, DM
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anatomic Landmarks
Axillary Vein - diagnostic imaging
Cardiovascular
Cohort Studies
Electrodes, Implanted
Female
Fluoroscopy - methods
Follow-Up Studies
Humans
India
Male
Middle Aged
Pacemaker, Artificial
Patient Safety
Prospective Studies
Radiography, Interventional - methods
Risk Assessment
Statistics, Nonparametric
Subclavian Vein - diagnostic imaging
Time Factors
Treatment Outcome
Young Adult
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Summary:Abstract Background The intrathoracic subclavian venous technique for pacemaker implantation may be associated with serious complications. We describe an alternative technique for obtaining venous access for pacemaker implantation through axillary vein under fluoroscopic guidance and compare it with the conventional, subclavian approach. Methods We conducted a single-centre, prospective, nonrandomized study. All adult patients with indication for permanent pacing who consented were recruited during a 3-year period. To access the axillary vein, we used the alternative technique with a new fluoroscopic landmark. The subclavian access was obtained as per the usual approach. Results We studied 478 lead placements during 3 years; 315 lead placements through axillary venous technique (group 1) were compared with 163 lead placements through subclavian venous technique (group 2). Both routes had a high and comparable success rate, 98.09% in group 1 and 96.93% in group 2. The axillary approach was successful at the first attempt in 194 punctures (61.6%), as vs 60 in group 2 (36.8%) P < 0.0001. The average number of attempts in group 1 was 2.06 per patient and 2.56 in group 2 ( P < 0.001). There were 3 (2.94%) pneumothoraxes in group 2 and none in group 1. During a mean follow-up period of 3.2 months in group1 and 3.7 months in group 2, 1 patient in group 2 had a lead fracture. Conclusions The fluoroscopically guided axillary venous approach for implanting permanent pacemakers is equivalent to the traditional anatomic landmark–guided intrathoracic subclavian approach and has fewer complications and shorter procedural time to access the vein.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2012.02.019