Axillary Versus Infraclavicular Placement for Endocardial Heart Rhythm Devices in Patients With Pediatric and Congenital Heart Disease

Our objective was to evaluate the implant and mid-term outcomes of transvenous pacemaker or internal cardioverter-defibrillator placement by alternative axillary approaches compared to the infraclavicular approach in a pediatric and congenital heart disease population. We conducted a retrospective r...

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Bibliographic Details
Published in:The American journal of cardiology 2010-12, Vol.106 (11), p.1646-1651
Main Authors: Rausch, Christopher M., MD, Hughes, Benjamin H., MD, Runciman, Martin, MB, BS, Law, Ian H., MD, Bradley, David J., MD, Sujeev, Mathur, MB, BS, Duke, Abdul, MB, BS, Schaffer, Michael, MD, Collins, Kathryn K., MD
Format: Article
Language:English
Subjects:
Adolescent
Axilla
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular
Cardiovascular disease
Clavicle
Congenital diseases
Defibrillators, Implantable
Electric Countershock - methods
Female
Follow-Up Studies
Heart Defects, Congenital - physiopathology
Heart Defects, Congenital - therapy
Heart Rate - physiology
Humans
Male
Medical sciences
Patients
Pediatrics
Prosthesis Implantation - methods
Retrospective Studies
Time Factors
Transplants & implants
Treatment Outcome
Young Adult
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Summary:Our objective was to evaluate the implant and mid-term outcomes of transvenous pacemaker or internal cardioverter-defibrillator placement by alternative axillary approaches compared to the infraclavicular approach in a pediatric and congenital heart disease population. We conducted a retrospective review of all patients with new endocardial heart rhythm devices placed at 4 pediatric arrhythmia centers. A total of 317 patients were included, 63 had undergone a 2-incision axillary approach, 51 a retropectoral axillary approach, and 203 an infraclavicular approach. Congenital heart disease was present in 62% of the patients. The patients with the 2-incision axillary approach were younger and smaller. The patients with the retropectoral axillary approach were less likely to have undergone previous cardiac surgery and were more likely to have had an internal cardioverter-defibrillator placed. The duration of follow-up was 2.4 ± 1.9 years for the 2-incision axillary, 2.6 ± 2.6 years for retropectoral axillary, and 3.5 ± 1.4 years for the infraclavicular technique (p = 0.01). No differences were seen in implant characteristics, lead longevity, implant complications, lead fractures or dislodgements, inappropriate internal cardioverter-defibrillator discharges, or device infections among the 3 groups. In conclusion, our data support that the outcomes of axillary approaches are comparable to the infraclavicular approach for endocardial heart rhythm device placement and that axillary approaches should be considered a viable option in patients with pediatric and congenital heart disease.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2010.07.025