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Vetta G, Parlavecchio A, Wright J, Magnocavallo M, Marcon L, Doundoulakis I, Scacciavillani R, Sorgente A, Pannone L, Almorad A, Sieira J, Audiat C, Nakasone K, Bala G, Ströker E, Overeinder I, Rossi P, Sarkozy A, Chierchia GB, de Asmundis C, Della Rocca DG. Ultrasound-guided versus fluoroscopy-guided axillary vein puncture for cardiac implantable electronic device implantation: a meta-analysis enrolling 1257 patients. J Interv Card Electrophysiol 2025; 68:589-596. [PMID: 39448460 DOI: 10.1007/s10840-024-01932-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 10/09/2024] [Indexed: 10/26/2024]
Abstract
INTRODUCTION Ultrasound-guided (Echo-AVP) and Fluoroscopy-guided Axillary Vein Puncture (Fluoro-AVP) are both acknowledged as safe and effective techniques for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of Echo-AVP versus Fluoro-AVP for CIEDs implantation. METHODS We systematically searched Medline, Embase and Cochrane electronic databases up to May 15th, 2024, for studies that evaluated the efficacy and safety of Echo-AVP and Fluoro-AVP reporting at least one clinical outcome of interest. The primary efficacy endpoint was acute procedural success and the primary safety endpoint was a composite endpoint of pneumothorax, pocket hematoma/bleeding, pocket infection and inadvertent arterial puncture. The effect size was estimated using a random-effect model as Odds Ratio (OR) and Mean Difference (MD) with relative 95% Confidence Interval (CI). RESULTS Overall, 4 studies were included, which enrolled 1257 patients (Echo-AVP: 373 patients; Fluoro-AVP: 884 patients). Echo-AVP led to a significant reduction in the primary safety endpoint (OR: 0.41; p = 0.0009), risk of inadvertent arterial puncture (OR: 0.29; p = 0.003) and fluoroscopy time ( MD: -105.02; p = 0.008). No differences were found between Echo-AVP and Fluoro-AVP for acute procedural success (OR: 0.77; p = 0.27), pneumothorax (OR: 0.66; p = 0.60), pocket hematoma/bleeding (OR: 0.68; p = 0.30), pocket infection (OR: 0.66; p = 0.60), procedural time (MD: 1.99; p = 0.65), success rate at first attempt (OR: 1.25; p = 0.34) and venous access time (MD: -0. 25; p = 0.99). CONCLUSION Echo-AVP proved to reduce significantly the primary safety endpoint, inadvertent arterial puncture and fluoroscopy time compared to Fluoro-AVP.
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Affiliation(s)
- Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy
| | - Antonio Parlavecchio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Jennifer Wright
- School of Medicine and Public Health, Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michele Magnocavallo
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Lorenzo Marcon
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Ioannis Doundoulakis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Roberto Scacciavillani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Charles Audiat
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Kazutaka Nakasone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy.
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Menezes Junior ADS, Barbosa GA, Martins Santos CK, Ramos Miranda MC. Ultrasound-Guided Axillary Vein Puncture for Cardiac Device Implantation: A Systematic Review and Meta-Analysis. Cardiol Rev 2025:00045415-990000000-00458. [PMID: 40167324 DOI: 10.1097/crd.0000000000000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
Ultrasound-guided axillary vein puncture (US-AVP) has recently emerged as a valid alternative to standard vein puncture (SVP) for cardiac implantable electronic device implantation. This meta-analysis aimed to compare the efficacy and safety of US-AVP versus SVP. A comprehensive search of PubMed, Embase, and Cochrane databases identified randomized clinical trials and nonrandomized clinical trials comparing these techniques. Pooled relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models, and trial sequential analysis was conducted to assess the robustness of findings. Twelve studies met the inclusion criteria, including 3085 patients (1227 in the US-AVP group and 1858 in the SVP group). US-AVP significantly reduced total complication rates compared with SVP [RR, 0.65 (95% CI, 0.48-0.89); P = 0.006; I² = 0%], with no significant difference in success rates [RR, 1.05 (95% CI, 0.99-1.11); P = 0.137; I² = 60%]. Fluoroscopy duration was significantly shorter in the US-AVP group [MD, -1.58 min (95% CI, -2.16 to -0.99); P < 0.001; I² = 81%], and X-ray exposure was markedly lower [MD, -3.23 mGy·cm² (95% CI, -6.03 to -0.43); P = 0.024; I² = 93%]. The trial sequential analysis supported the robustness of the evidence for reduced complications. In conclusion, US-AVP demonstrated a safety advantage over SVP by reducing complications while achieving comparable efficacy.
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Affiliation(s)
- Antonio da Silva Menezes Junior
- From the Medicine Department, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Brazil
- Internal Medicine Department, Medical Faculty, Federal University of Goiás, Goiânia, Brazil
| | - Gabriel Alves Barbosa
- From the Medicine Department, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Brazil
| | - Charles Karel Martins Santos
- From the Medicine Department, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Brazil
| | - Maria Clara Ramos Miranda
- From the Medicine Department, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Brazil
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Simpson J, Yoder M, Christian-Miller N, Wheat H, Kovacs B, Cunnane R, Ghannam M, Liang JJ. Long-Term Complications Related to Cardiac Implantable Electronic Devices. J Clin Med 2025; 14:2058. [PMID: 40142866 PMCID: PMC11942853 DOI: 10.3390/jcm14062058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/08/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025] Open
Abstract
Cardiac implantable electronic devices (CIEDs) are commonly used for a number of cardiac-related conditions, and it is estimated that over 300,000 CIEDs are placed annually in the US. With advances in technology surrounding these devices and expanding indications, CIEDs can remain implanted in patients for long periods of time. Although the safety profile of these devices has improved over time, both the incidence and prevalence of long-term complications are expected to increase. This review highlights pertinent long-term complications of CIEDs, including lead-related issues, device-related arrhythmias, inappropriate device therapies, and device-related infections. We also explore key clinical aspects of each complication, including common presentations, patient-specific and non-modifiable risk factors, diagnostic evaluation, and recommended management strategies. Our goal is to help spread awareness of CIED-related complications and to empower physicians to manage them effectively.
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Affiliation(s)
- Jamie Simpson
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.S.); (M.Y.); (N.C.-M.)
| | - Mason Yoder
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.S.); (M.Y.); (N.C.-M.)
| | - Nathaniel Christian-Miller
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.S.); (M.Y.); (N.C.-M.)
| | - Heather Wheat
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
| | - Boldizsar Kovacs
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
| | - Ryan Cunnane
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
| | - Michael Ghannam
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
| | - Jackson J. Liang
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
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Trohman RG. Leadless Pacing: Current Status and Ongoing Developments. MICROMACHINES 2025; 16:89. [PMID: 39858744 PMCID: PMC11767621 DOI: 10.3390/mi16010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 01/01/2025] [Accepted: 01/06/2025] [Indexed: 01/27/2025]
Abstract
Although significant strides have been made in cardiac pacing, the field is still evolving. While transvenous permanent pacing is highly effective in the management of bradyarrhythmias, it is not risk free and may result in significant morbidity and, rarely, mortality. Transvenous leads are often the weakest link in a pacing system. They may dislodge, fracture, or suffer breaches in their insulation. This review was undertaken to clarify leadless risks, benefits, and alternatives to transvenous cardiac pacing for bradyarrhythmias and heart failure management. In order to clarify the role(s) of leadless pacing, this narrative review was undertaken by searching MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and review articles, as well as other clinically relevant reports and studies. The search was limited to English-language reports published between 1932 and 2024. Leadless pacing was searched using the terms Micra™, Nanostim™, AVEIR™, single-chamber leadless pacemaker, dual-chamber leadless pacemaker, cardiac resynchronization therapy (CRT), cardiac physiological pacing (CPP) and biventricular pacing (BiV). Google and Google Scholar, as well as bibliographies of identified articles were also reviewed for additional references. The advantages and limitations of leadless pacing as well as options that are under investigation are discussed in detail.
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Affiliation(s)
- Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, 1653 W. Congress, Chicago, IL 60612, USA
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Pillai A, Huizar JF, Koneru JN, Kaszala K. Cardiac Device Implantation: Techniques and Best Practices. Card Electrophysiol Clin 2024; 16:325-338. [PMID: 39461824 DOI: 10.1016/j.ccep.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
Transvenous leads continue to be the standard means to deliver bradyarrhythmia and tachyarrhythmia device therapy. Risk factors for cardiac implantable electronic devices (CIED) infection or complications of transvenous lead extraction (TLE) and mortality represent a complex interplay between non-modifiable patient-related factors and actionable implant-related characteristics or adverse events. Careful attention to patient screening, infection mitigation, lead selection, and implant technique may enhance safety of the index procedure and subsequent clinical management.
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Affiliation(s)
- Ajay Pillai
- Section of Cardiac Electrophysiology, Divison of Cardiology, Department of Medicine, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall Street, Richmond, VA 23298, USA.
| | - Jose F Huizar
- Section of Cardiac Electrophysiology, Divison of Cardiology, Department of Medicine, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall Street, Richmond, VA 23298, USA; Division of Cardiac Electrophysiology, Central Virginia Veterans Affairs Health System, Richmond, VA, USA. https://twitter.com/JoseFcoHuizar
| | - Jayanthi N Koneru
- Section of Cardiac Electrophysiology, Divison of Cardiology, Department of Medicine, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall Street, Richmond, VA 23298, USA. https://twitter.com/jaykoneru
| | - Karoly Kaszala
- Section of Cardiac Electrophysiology, Divison of Cardiology, Department of Medicine, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall Street, Richmond, VA 23298, USA; Division of Cardiac Electrophysiology, Central Virginia Veterans Affairs Health System, Richmond, VA, USA
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6
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Vitali F, Zuin M, Charles P, Jiménez-Díaz J, Sheldon SH, Tagliari AP, Migliore F, Malagù M, Montoy M, Sobrino FH, Courtney AM, Kochi AN, Fareh S, Bertini M. Ultrasound-guided vs. fluoro-guided axillary venous access for cardiac implantable electronic devices: a patient-based meta-analysis. Europace 2024; 26:euae274. [PMID: 39471341 PMCID: PMC11579654 DOI: 10.1093/europace/euae274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/10/2024] [Accepted: 10/22/2024] [Indexed: 11/01/2024] Open
Abstract
AIMS The use of ultrasound (US)-guided venous puncture for cardiac pacing/defibrillation lead placement may minimize the risk of periprocedural complications and radiation exposure. However, none of the published studies have been sufficiently powered to recommend this approach as the standard of care. We compare the safety and efficacy of ultrasound-guided axillary venous puncture (US-AVP) vs. fluoroscopy-guided access for cardiac implantable electronic devices (CIEDs) by performing an individual patient data meta-analysis based on previously published studies. METHODS AND RESULTS We conducted a thorough literature search encompassing longitudinal investigations (five randomized and one prospective studies) reporting data on X-ray-guided and US-AVP for CIED procedures. The primary endpoint was to compare the safety of the two techniques. Secondary endpoints included the success rate of each technique, the necessity of switching to alternative methods, the time needed to obtain venous access, X-ray exposure, and the occurrence of periprocedural complications. Six longitudinal eligible studies were identified including 700 patients (mean age 74.9 ± 12.1 years, 68.4% males). The two approaches for venous cannulation showed a similar success rate. The use of an X-ray-guided approach significantly increased the risk of inadvertent arterial punctures (OR: 2.15, 95% CI: 2.10-2.21, P = 0.003), after adjustment for potential confounders. Conversely, a US-AVP approach reduces time to vascular access, radiation exposure, and the number of attempts to vascular access. CONCLUSION The US-AVP enhances safety by reducing radiation exposure and time to vascular access while maintaining a low rate of major complications compared to the X-ray-guided approach. CLINICAL TRIAL REGISTRATION PROSPERO identifier: CRD42024539623.
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Affiliation(s)
- Francesco Vitali
- Cardiology Department, Sant’Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Marco Zuin
- Cardiology Department, Sant’Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Paul Charles
- Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Javier Jiménez-Díaz
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario of Ciudad Real, Ciudad Real, Spain
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Ana Paula Tagliari
- Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Cardiovascular Surgery, Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Michele Malagù
- Cardiology Department, Sant’Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Mathieu Montoy
- Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Felipe Higuera Sobrino
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario of Ciudad Real, Ciudad Real, Spain
| | - Alex M Courtney
- Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Adriano Nunes Kochi
- Department of Cardiovascular Surgery, Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Samir Fareh
- Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Matteo Bertini
- Cardiology Department, Sant’Anna University Hospital, University of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
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Leventopoulos G, Travlos CK, Theofilatos A, Spyropoulou P, Papageorgiou A, Perperis A, Koros R, Moulias A, Koniari I, Davlouros P. Ultrasound-Guided Axillary Access Using a Micropuncture Needle Versus Conventional Cephalic Venous Access for Implantation of Cardiac Devices: A Single-Center Randomized Trial. J Pers Med 2024; 14:1084. [PMID: 39590576 PMCID: PMC11595823 DOI: 10.3390/jpm14111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 10/22/2024] [Accepted: 10/29/2024] [Indexed: 11/28/2024] Open
Abstract
(1) Background: Ultrasound-guided axillary (USAX) vein puncture is a relatively new method to obtain venous access for the implantation of cardiac implantable electronic devices (CIED). However, its use is limited as most of the operators are not familiar with this technique. Our aim was to investigate the safety and efficacy of the USAX compared with the traditional cephalic vein dissection for venous access in CIED implantation. (2) Methods: This was a single-center, randomized, controlled, superiority trial. A total of 114 patients were randomized (1:1 ratio) to either USAX (u/s axillary group; 59 patients) or cephalic vein access (cephalic group; 55 patients). The primary study endpoint was defined as successful placement of all leads via the chosen access. Secondary study endpoints included time from local anesthetic injection to lead advancement in the SVC, total procedure time (skin to skin), procedure-related complications and pain perception. (3) Results: USAX was superior to cephalic access in terms of primary endpoint (OR: 4.3, 95% CI: 1.3, 14.0; p = 0.012). Total procedure duration was higher in the cephalic group (55.15 ± 16.62 vs. 48.35 ± 12.81 min, p = 0.017) but there was neither a significant difference in fluoroscopy time (p = 0.872) nor in total radiation dose (p = 0.815). The level of pain was higher in the cephalic group (p = 0.016), while the rates of complications were similar in both groups (p > 0.05). (4) Conclusion: USAX was superior to cephalic access regarding success rate, total procedure duration and level of pain, while having no difference in complication rates.
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Affiliation(s)
- Georgios Leventopoulos
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
| | | | - Athinagoras Theofilatos
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
| | - Panagiota Spyropoulou
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
| | - Angeliki Papageorgiou
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
| | - Angelos Perperis
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
| | - Rafail Koros
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
| | - Athanasios Moulias
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, Rio, 26504 Patras, Greece; (A.T.); (P.S.); (A.P.); (A.P.); (R.K.); (A.M.); (I.K.); (P.D.)
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8
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Venet A, Vergier R, Cenac K, Inamo J, Müssigbrodt A. Axillary and subclavian venous spasm during pacemaker implantation - A case report and literature review. Clin Case Rep 2024; 12:e9309. [PMID: 39139620 PMCID: PMC11319219 DOI: 10.1002/ccr3.9309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/01/2024] [Accepted: 07/28/2024] [Indexed: 08/15/2024] Open
Abstract
Key Clinical Message Venous spasm is an important reason for complicated or failed implantations of cardiac implantable electronic devices. Prevention or risk reduction of venous spasm during cardiac implantable electronic device implantation may be achieved by ultrasound or fluoroscopic imaging prior to puncture, cephalic vein cut-down, sufficient pre- and perioperative hydration, nitroglycerin injection and effective sedation, and analgesia. Abstract This case report with literature review focuses on venous spasm as a potential cause for complicated implantations of cardiac implantable electronic devices. The case report is clinically relevant as it describes a progressive spasm affecting the axillary and the subclavian vein. A 66-year-old female complained of symptomatic atrial fibrillation (AF) and atypical atrial flutter despite interventional and medical treatment. As an ultimate treatment, she was scheduled for pacemaker implantation and atrioventricular node ablation. Several puncture attempts of the axillary vein failed. Despite venous blood aspiration, no guidewires could be advanced into the axillary vein. We performed a first venogram revealing significant spasm of the axillary vein. Another failed venous puncture occurred after change of access site to the subclavian vein. A second venogram displayed progression of the spasm, now affecting both the axillary and the subclavian veins. Normal saline perfusion was administered as well as intravenous isosorbide. Unfortunately, a repeated venogram after 15 min waiting time showed persistence of the spasm, still affecting both veins. The procedure was discontinued as the patient became uncomfortable. Venous spasm is an important reason for complicated or failed implantations of cardiac implantable electronic devices. Commonly used medical prevention and treatment are intravenous fluids and nitroglycerin. Prevention or risk reduction of venous spasm during cardiac implantable electronic device implantation may be achieved by ultrasound or fluoroscopic imaging prior to puncture, cephalic vein cut-down, sufficient pre- and perioperative hydration, nitroglycerin injection and effective sedation and analgesia.
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Affiliation(s)
- Amelie Venet
- Department of CardiologyCHU Martinique (University Hospital of Martinique)Fort de FranceMartinique
| | - Romain Vergier
- Department of CardiologyCHU Martinique (University Hospital of Martinique)Fort de FranceMartinique
| | - Kurlene Cenac
- Department of CardiologyTapion Hospital and OKEU HospitalCastriesSaint Lucia
| | - Jocelyn Inamo
- Department of CardiologyCHU Martinique (University Hospital of Martinique)Fort de FranceMartinique
| | - Andreas Müssigbrodt
- Department of CardiologyCHU Martinique (University Hospital of Martinique)Fort de FranceMartinique
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Morani G, Bolzan B, Pepe A, Berton G, Strazzanti M, Ribichini FL. The axillary vein puncture for implantable cardiac defibrillator implantation: 14 years of experience. Analysis of the results. Int J Cardiol 2024; 407:132113. [PMID: 38697398 DOI: 10.1016/j.ijcard.2024.132113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/20/2024] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Axillary vein puncture (AVP) is a valid alternative to Subclavan vein puncture for leads insertion in cardiac implantable electronic device implantation, that may reduce acute and delayed complications. Very few data are available about ICD recipients. A simplified AVP technique is described. METHODS All the patients who consecutively underwent "de novo" ICD implantation, from March 2006 to December 2020 at the University of Verona, were considered. Leads insertion was routinely performed through an AVP, according to a simplified technique. Outcome and complications have been retrospectively analyzed. RESULTS The study population consisted of 1711 consecutive patients. Out of 1711 patients, 38 (2.2%) were excluded because they were implanted with Medtronic Sprint Fidelis lead. Out of 1673 ICD implantations, 963 (57.6%) were ICD plus cardiac resynchronization therapy, 434 (25.9%) were dual-chamber defibrillators, and 276 (16.5%) were single-chamber defibrillators, for a total of 3879 implanted leads. The AVP success rate was 99.4%. Acute complications occurred in 7/1673 (0.42%) patients. Lead failure (LF) occurred in 20/1673 (1.19%) patients. Comparing the group of patients with lead failure with the group without LF, the presence of three leads inside the vein was significantly associated with LF, and the multivariate analysis confirmed three leads in place as an independent predictor of LF. CONCLUSION AVP, according to our simplified technique, is safe, effective, has a high success rate, and a very low complication rate. The incidence of LF was exceptionally low. The advantages of AVP are maintained over time in a population of ICD recipients.
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Affiliation(s)
- Giovanni Morani
- Alto Vicentino Hospital, Aussl 7 Pedemontana, Santorso, VI, Italy.
| | - Bruna Bolzan
- Division of Cardiology, University of Verona, Verona, Italy
| | - Antonio Pepe
- Alto Vicentino Hospital, Aussl 7 Pedemontana, Santorso, VI, Italy
| | - Giampaolo Berton
- Alto Vicentino Hospital, Aussl 7 Pedemontana, Santorso, VI, Italy
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10
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Kaul R, Yang F, Shokr M, Jankelson L, Knotts RJ, Holmes D, Aizer A, Chinitz LA, Barbhaiya CR. Caudal tilt ultrasound-guided axillary venous access for transvenous pacing lead implant. Heart Rhythm 2024; 21:662-667. [PMID: 38266750 DOI: 10.1016/j.hrthm.2024.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Risheek Kaul
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Felix Yang
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Robert J Knotts
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York.
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11
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Silvetti MS, Colonna D, Gabbarini F, Porcedda G, Rimini A, D’Onofrio A, Leoni L. New Guidelines of Pediatric Cardiac Implantable Electronic Devices: What Is Changing in Clinical Practice? J Cardiovasc Dev Dis 2024; 11:99. [PMID: 38667717 PMCID: PMC11050217 DOI: 10.3390/jcdd11040099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Guidelines are important tools to guide the diagnosis and treatment of patients to improve the decision-making process of health professionals. They are periodically updated according to new evidence. Four new Guidelines in 2021, 2022 and 2023 referred to pediatric pacing and defibrillation. There are some relevant changes in permanent pacing. In patients with atrioventricular block, the heart rate limit in which pacemaker implantation is recommended was decreased to reduce too-early device implantation. However, it was underlined that the heart rate criterion is not absolute, as signs or symptoms of hemodynamically not tolerated bradycardia may even occur at higher rates. In sinus node dysfunction, symptomatic bradycardia is the most relevant recommendation for pacing. Physiological pacing is increasingly used and recommended when the amount of ventricular pacing is presumed to be high. New recommendations suggest that loop recorders may guide the management of inherited arrhythmia syndromes and may be useful for severe but not frequent palpitations. Regarding defibrillator implantation, the main changes are in primary prevention recommendations. In hypertrophic cardiomyopathy, pediatric risk calculators have been included in the Guidelines. In dilated cardiomyopathy, due to the rarity of sudden cardiac death in pediatric age, low ejection fraction criteria were demoted to class II. In long QT syndrome, new criteria included severely prolonged QTc with different limits according to genotype, and some specific mutations. In arrhythmogenic cardiomyopathy, hemodynamically tolerated ventricular tachycardia and arrhythmic syncope were downgraded to class II recommendation. In conclusion, these new Guidelines aim to assess all aspects of cardiac implantable electronic devices and improve treatment strategies.
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Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart), 00100 Rome, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, 80131 Naples, Italy;
| | - Fulvio Gabbarini
- Paediatric Cardiology and Adult Congenital Heart Disease Unit, Regina Margherita Hospital, 10126 Torino, Italy;
| | - Giulio Porcedda
- Paediatric Cardiology Unit, A. Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Alessandro Rimini
- Paediatric Cardiology Unit, G. Gaslini Children’s Hospital IRCCS, 16147 Genoa, Italy;
| | - Antonio D’Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmia, Monaldi Hospital, 80131 Naples, Italy;
| | - Loira Leoni
- Cardiology Unit, Department of Cardio-Thoracic-Vascular Science and Public Health, Padua University Hospital (ERN GUARD-Heart), 35121 Padua, Italy;
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12
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Loudon BL, Wong GR. Changing the view: Preventing pneumothorax during transvenous pacemaker implantation. J Cardiovasc Electrophysiol 2024; 35:438-439. [PMID: 38303162 DOI: 10.1111/jce.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Brodie L Loudon
- Department of Cardiology, The Northern Hospital Epping, Melbourne, Victoria, Australia
| | - Geoffrey R Wong
- Department of Cardiology, The Northern Hospital Epping, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
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13
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Morton MB, William J, Kistler PM, Prabhu S, Sugumar H, Brink OVD, Patel H, Mariani J, Voskoboinik A. Caudal fluoroscopic guidance for the insertion of transvenous pacing leads. J Cardiovasc Electrophysiol 2024; 35:433-437. [PMID: 38205869 DOI: 10.1111/jce.16183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
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 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 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 Caudal fluoroscopy for axillary/subclavian access is associated with a lower rate of pneumothorax and contrast venography compared with an AP approach.
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Affiliation(s)
- Matthew B Morton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jeremy William
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter M Kistler
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sandeep Prabhu
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Hariharan Sugumar
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Hitesh Patel
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Justin Mariani
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
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14
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Charles P, Ditac G, Montoy M, Thenard T, Courand PY, Lantelme P, Harbaoui B, Fareh S. Intra-pocket ultrasound-guided axillary vein puncture vs. cephalic vein cutdown for cardiac electronic device implantation: the ACCESS trial. Eur Heart J 2023; 44:4847-4858. [PMID: 37832512 DOI: 10.1093/eurheartj/ehad629] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 08/06/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND AIMS Intra-pocket ultrasound-guided axillary vein puncture (IPUS-AVP) for venous access in implantation of transvenous cardiac implantable electronic devices (CIED) is uncommon due to the lack of clinical evidence supporting this technique. This study investigated the efficacy and early complications of IPUS-AVP compared to the standard method using cephalic vein cutdown (CVC) for CIED implantation. METHODS ACCESS was an investigator-led, interventional, randomized (1:1 ratio), monocentric, controlled superiority trial. A total of 200 patients undergoing CIED implantation were randomized to IPUS-AVP (n = 101) or CVC (n = 99) as a first assigned route. The primary endpoint was the success rate of insertion of all leads using the first assigned venous access technique. The secondary endpoints were time to venous access, total procedure duration, fluoroscopy time, X-ray exposure, and complications. Complications were monitored during a follow-up period of three months after procedure. RESULTS IPUS-AVP was significantly superior to CVC for the primary endpoint with 100 (99.0%) vs. 86 (86.9%) procedural successes (P = .001). Cephalic vein cutdown followed by subclavian vein puncture was successful in a total of 95 (96.0%) patients, P = .21 vs. IPUS-AVP. All secondary endpoints were also significantly improved in the IPUS-AVP group with reduction in time to venous access [3.4 vs. 10.6 min, geometric mean ratio (GMR) 0.32 (95% confidence interval, CI, 0.28-0.36), P < .001], total procedure duration [33.8 vs. 46.9 min, GMR 0.72 (95% CI 0.67-0.78), P < .001], fluoroscopy time [2.4 vs. 3.3 min, GMR 0.74 (95% CI 0.63-0.86), P < .001], and X-ray exposure [1083 vs. 1423 mGy.cm², GMR 0.76 (95% CI 0.62-0.93), P = .009]. There was no significant difference in complication rates between groups (P = .68). CONCLUSIONS IPUS-AVP is superior to CVC in terms of success rate, time to venous access, procedure duration, and radiation exposure. Complication rates were similar between the two groups. Intra-pocket ultrasound-guided axillary vein puncture should be a recommended venous access technique for CIED implantation.
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Affiliation(s)
- Paul Charles
- Fédération de Cardiologie, Hôpital de la Croix Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Geoffroy Ditac
- Fédération de Cardiologie, Hôpital de la Croix Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Mathieu Montoy
- Fédération de Cardiologie, Hôpital de la Croix Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Thibaut Thenard
- Fédération de Cardiologie, Hôpital de la Croix Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Pierre-Yves Courand
- Fédération de Cardiologie, Hôpital de la Croix Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
- Université de Lyon, CREATIS UMR5220, INSERM U1044, INSA Lyon, 7 avenue Jean Capelle, 69621 Villeurbanne Cedex, Lyon, France
| | - Pierre Lantelme
- Fédération de Cardiologie, Hôpital de la Croix Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
- Université de Lyon, CREATIS UMR5220, INSERM U1044, INSA Lyon, 7 avenue Jean Capelle, 69621 Villeurbanne Cedex, Lyon, France
| | - Brahim Harbaoui
- Fédération de Cardiologie, Hôpital de la Croix Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
- Université de Lyon, CREATIS UMR5220, INSERM U1044, INSA Lyon, 7 avenue Jean Capelle, 69621 Villeurbanne Cedex, Lyon, France
| | - Samir Fareh
- Fédération de Cardiologie, Hôpital de la Croix Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
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15
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Brignole M, Deharo JC. Different techniques of venous access for CIEDs: advantages and disadvantages. Eur Heart J 2023; 44:4859-4861. [PMID: 37949825 DOI: 10.1093/eurheartj/ehad749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Michele Brignole
- IRCCS Istituto Auxologico Italiano, Department of Cardiology, San Luca Hospital, Ospedale San Luca, Piazzale Brescia 20, 20149 Milan, Italy
| | - Jean-Claude Deharo
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, France and Aix Marseille Université, C2VN, 13005 Marseille, France
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16
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Mian M, Khan HR. Ultrasound utilization for implantation of cardiac implantable electronic devices. Wien Klin Wochenschr 2023; 135:712-718. [PMID: 37353694 PMCID: PMC10713767 DOI: 10.1007/s00508-023-02215-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/20/2023] [Indexed: 06/25/2023]
Abstract
Ultrasound (US) guidance for implantation of cardiac implantable electronic devices (CIED) is currently not routine practice. This article sought to review published data on the use of ultrasound in each of the major surgical steps involved in implantation of CIEDs, including achieving anesthesia, obtaining venous access and implantation of leads. A literature review was performed, revealing a total of 20 peer-reviewed studies that assessed US guidance for CIED implantation; 3 of these were randomized trials while the remainder were mostly feasibility studies. The available data suggest that ultrasound can be useful in guiding implantation of CIEDs, with a trend towards less complication rates; however, more high-quality studies that compare US guidance to traditional techniques in CIED implantation are required.
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Affiliation(s)
- Muhtashim Mian
- University Hospital, University of Western Ontario, 339 Windermere Rd., N6A 5A5, London, Ontario, Canada
| | - Habib Rehman Khan
- University Hospital, University of Western Ontario, 339 Windermere Rd., N6A 5A5, London, Ontario, Canada.
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17
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Martens E, Sommer P, Johnson V, Tilz RR, Althoff T, Jansen H, Steven D, Steger A, Iden L, Estner H, Rillig A, Duncker D. [Venous access routes for cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:250-255. [PMID: 37460626 DOI: 10.1007/s00399-023-00954-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 08/29/2023]
Abstract
Various venous access routes in the region of the clavicle are available for cardiac device treatment. After many years of choosing access via the subclavian vein, current data explicitly show that lateral approaches such as preparation of the cephalic vein or puncture of the axillary vein are clearly superior in terms of probe durability and risk of complications. This article describes the preparation and performance of the various access techniques and is intended to provide a practical guide for the work in cardiac pacemaker operations. This work continues a series of articles designed for advanced training in specialized rhythmology.
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Affiliation(s)
- Eimo Martens
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Victoria Johnson
- Klinik für Kardiologie und Angiologie, Universitätsklinikum Giessen, Giessen, Deutschland
| | - Roland R Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Carrer de Villarroel 170, 08036, Barcelona, Spanien
| | | | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Alexander Steger
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar der technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Matteucci A, Bonanni M, Massaro G, Chiricolo G, Stifano G, Forleo GB, Biondi-Zoccai G, Sangiorgi G. Treatment with gentamicin-impregnated collagen sponges in reducing infection of implantable cardiac devices: 10-year analysis with propensity score matching. Rev Port Cardiol 2023; 42:711-717. [PMID: 37085085 DOI: 10.1016/j.repc.2023.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/01/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The incidence of device infection has increased over time and is associated with increased mortality in patients with cardiac implantable electronic devices (CIEDs). Gentamicin-impregnated collagen sponges (GICSs) are useful in preventing surgical site infection (SSI) in cardiac surgery. Nevertheless, to date, there is no evidence concerning their use in CIED procedures. Our study aims to determine the effectiveness of treatment with GICSs in preventing CIED infection. METHODS A total of 2986 adult patients who received CIEDs between 2010 and 2020 were included. Before device implantation, all patients received routine periprocedural systemic antibiotic prophylaxis. The study endpoints were the CIED infection rate at one year and the effectiveness of the use of GICSs in reducing CIED infection. RESULTS Among 1524 pacemaker, 942 ICD and 520 CRT implantations, CIED infection occurred in 36 patients (1.2%). Early reintervention (OR 9 [95% CI 3.180-25.837], p<0.001), pocket hematoma (OR 11 [95% CI 4.195-28.961], p<0.001), diabetes (OR 2.9 [95% CI 1.465-5.799], p=0.002) and prolonged procedural time (OR 1.02 [95% CI 1.008-1.034], p=0.001) were independent risk factors for CIED infection. Treatment with GICSs reduced CIED infections significantly ([95% CI -0.031 to -0.001], p<0.001). CONCLUSIONS The use of GICSs may help in reducing infections associated with CIED implantation.
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Affiliation(s)
- Andrea Matteucci
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy; Division of Cardiology, San Filippo Neri Hospital, Via Martinotti, 20, Rome, Italy.
| | - Michela Bonanni
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | - Gianluca Massaro
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | - Gaetano Chiricolo
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Stifano
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
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19
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Vetta G, Magnocavallo M, Parlavecchio A, Caminiti R, Polselli M, Sorgente A, Cauti FM, Crea P, Pannone L, Marcon L, Savio AL, Pistelli L, Vetta F, Chierchia GB, Rossi P, Bianchi S, Natale A, de Asmundis C, Rocca DGD. Axillary vein puncture versus cephalic vein cutdown for cardiac implantable electronic device implantation: A meta-analysis. Pacing Clin Electrophysiol 2023; 46:942-947. [PMID: 37378419 DOI: 10.1111/pace.14728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Cephalic vein cutdown (CVC) and axillary vein puncture (AVP) are both recommended for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile. METHODS We systematically searched Medline, Embase, and Cochrane electronic databases up to September 5, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary endpoints were acute procedural success and overall complications. The effect size was estimated using a random-effect model as risk ratio (RR) and relative 95% confidence interval (CI). RESULTS Overall, seven studies were included, which enrolled 1771 and 3067 transvenous leads (65.6% [n = 1162] males, average age 73.4 ± 14.3 years). Compared to CVC, AVP showed a significant increase in the primary endpoint (95.7 % vs. 76.1 %; RR: 1.24; 95% CI: 1.09-1.40; p = .001) (Figure 1). Total procedural time (mean difference [MD]: -8.25 min; 95% CI: -10.23 to -6.27; p < .0001; I2 = 0%) and venous access time (MD: -6.24 min; 95% CI: -7.01 to -5.47; p < .0001; I2 = 0%) were significantly shorter with AVP compared to CVC. No differences were found between AVP and CVC for incidence overall complications (RR: 0.56; 95% CI: 0.28-1.10; p = .09), pneumothorax (RR: 0.72; 95% CI: 0.13-4.0; p = .71), lead failure (RR: 0.58; 95% CI: 0.23-1.48; p = .26), pocket hematoma/bleeding (RR: 0.58; 95% CI: 0.15-2.23; p = .43), device infection (RR: 0.95; 95% CI: 0.14-6.60; p = .96) and fluoroscopy time (MD: -0.24 min; 95% CI: -0.75 to 0.28; p = .36). CONCLUSION Our meta-analysis suggests that AVP may improve procedural success and reduce total procedural time and venous access time compared to CVC.
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Affiliation(s)
- Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Magnocavallo
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Polselli
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Filippo Maria Cauti
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Lorenzo Marcon
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Armando Lo Savio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lorenzo Pistelli
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Vetta
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Stefano Bianchi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
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Vélez ÁB. Cephalic Vein Cut Down for Total Implantable Venous Access Ports: A Retrospective Review of a Single Institution Series. EJVES Vasc Forum 2023; 59:2-7. [PMID: 37213486 PMCID: PMC10196808 DOI: 10.1016/j.ejvsvf.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/16/2023] [Accepted: 04/05/2023] [Indexed: 05/23/2023] Open
Abstract
Objective The aim of this work was to describe the early and late success rates of cephalic vein cut down (CVC) in the implantation of totally implantable venous access ports (TIVAP) for chemotherapy treatment in oncological patients. Methods This was a retrospective study of 1 047 TIVAP performed in a private institution between 2008 and 2021. The CVC with pre-operative ultrasound (PUS) was the initial approach. All cephalic veins (CVs) were mapped pre-operatively with Doppler ultrasound, measuring their diameter and course in oncological patients who required a TIVAP. With a CV diameter ≥ 3.2 mm TIVAP was carried out by CVC; with CV diameter < 3.2 mm, subclavian vein puncture (SVP) was performed. Results 1 047 TIVAPs were implanted in 998 patients. The mean age was 61.5 ± 11.5 years, 624 were women (65.5%). Male patients were significantly older and with a higher incidence of colonic, digestive system, and laryngeal cancer. Initially, TIVAP was indicated in 858 cases (82%) by CVC and 189 (18%) by SVP. The success rate was 98.5% for CVC and 98.4% for SVP. There were no complications for CVC (0%) but five early complications (2.5%) in the SVP group. The rates of late complications were 4.4% in the CVC group and 5.0% in the SVP group, foreign body infection being the most frequent (57.5% of the cases) (p = .85). Conclusion The CVC or SVP using PUS for TIVAP deployment, performed through a single incision, is a safe and effective technique. This open but minimally invasive technique should be considered in oncological patients.
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Affiliation(s)
- Ángel Barba Vélez
- Department of Angiology and Vascular Surgery, IMQ Zorrotzaurre University Hospital, Ballets Olaeta Kalea, 4, Bilbao, Spain
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Albertini L, Kawada S, Nair K, Harris L. Incidence and Clinical Predictors of Early and Late Complications of Implantable Cardioverter-Defibrillators in Adults With Congenital Heart Disease. Can J Cardiol 2023; 39:236-245. [PMID: 36565849 DOI: 10.1016/j.cjca.2022.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The implantable cardioverter-defibrillator (ICD) has been proven to improve survival in adults with congenital heart disease (ACHD), but it is associated with a high rate of complications. We aimed to quantify the incidence of early (≤ 3 months; ECs) and late (> 3 months; LCs) complications in ACHD patients implanted with an ICD and to identify their clinical predictors. METHODS We retrospectively reviewed 207 patients who had ICD follow-up at Toronto General Hospital from 1996 to 2019. RESULTS The most common diagnoses were tetralogy of Fallot (32.4%), dextro-transposition of the great arteries (17.9%), and congenital corrected transposition of the great arteries (13%). No intraprocedural complications were observed. Median follow-up was 3.4 years (IQR 0.1-23). 24 patients (12%) developed EC (4 hematomas, 20 lead dislodgements). A total of 56 LCs occurred (46% lead failure, 21% infection, 11% prophylactic lead extraction, 9% neurologic pain, 9% erosion, 4% other) with an incidence rate of LCs of 18% per 5 person-years. Anatomic complexity (odds ratio 2.9; P = 0.02) and cardiac resynchronization therapy defibrillator implant (odds ratio 2.5; P = 0.04) were associated with ECs. Survival rates free from LCs were 92%, 86%, and 65%, respectively, after 1, 5, and 10 years. Presence of legacy leads (hazard ratio 2.9; P = 0.006) and subpulmonary ejection fraction (5% increase, hazard ratio 1.35; P = 0.031) were associated with LCs. CONCLUSIONS ACHD patients at risk of sudden cardiac death continue to benefit from newer device technology. However, these patients, particularly those with greater anatomic and device complexity, remain at increased risk of developing complications over their lifetime. Given the life expectancy of this population, careful consideration needs to be given when a device for primary prevention is being contemplated.
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Affiliation(s)
- Lisa Albertini
- Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Satoshi Kawada
- Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Krishnakumar Nair
- Toronto General Hospital, University Health Network Toronto, Ontario, Canada
| | - Louise Harris
- Toronto General Hospital, University Health Network Toronto, Ontario, Canada.
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22
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Bodagh N, Cheng K, Eysenck W, Wong T. Synchronous atrioventricular sequential pacing utilizing conventional and leadless pacemakers in an elderly patient: a case report. Eur Heart J Case Rep 2022; 7:ytac474. [PMID: 36685101 PMCID: PMC9851417 DOI: 10.1093/ehjcr/ytac474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/15/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
Background Leadless pacemakers present a viable alternative to conventional transvenous devices to mitigate the risk of lead- and/or pocket-related complications. In elderly patients who have encountered ventricular lead failures with transvenous pacemakers, this option may enable the delivery of atrioventricular synchronous pacing therapy, while obviating the requirement for lead extraction and lead-based pacemaker re-implantation. Case summary This case report describes the successful implantation of a leadless pacemaker in a 90-year-old who had undergone two dual-chamber permanent pacemaker implantation procedures with a failure of three of four previously implanted leads. Atrioventricular synchronous pacing was achieved, as the leadless device was able to track the atrial-paced rhythm from the pre-existing right-sided device. Discussion In elderly patients who have encountered issues with transvenous pacemakers, alternative approaches should be considered to mitigate the risk of future complications. Leadless pacemakers may offer a low-risk solution, enabling the delivery of atrioventricular synchronous pacing therapy in such patient groups. Future studies should be designed to delineate whether these devices could be utilized as a first-line approach in certain situations.
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Affiliation(s)
- Neil Bodagh
- Corresponding author. Tel: +44 20 7188 7188,
| | - Kevin Cheng
- Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
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[Annual report 2020 of the German cardiac pacemaker and defibrillator register-Part 1: cardiac pacemakers]. Herzschrittmacherther Elektrophysiol 2022; 33:398-413. [PMID: 36100760 DOI: 10.1007/s00399-022-00893-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 01/28/2023]
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Zhu XY, Tang XH, Huang WY. Pacemaker electrode rupture causes recurrent syncope: A case report. World J Clin Cases 2022; 10:12352-12357. [PMID: 36483839 PMCID: PMC9724526 DOI: 10.12998/wjcc.v10.i33.12352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Currently, the implantation of permanent cardiac pacemakers entails mostly subclavian vein puncture, which is relatively simpler and easier to master. However, due to individual differences, some patients carry a narrow space between the clavicle and the first rib. If the range of activity of the upper limb is increased, the friction between the electrode wire and the bone gap leads to the breakage of the electrode wire, which is manifested by poor pacemaker perception and pacing.
CASE SUMMARY A 68-year-old woman underwent permanent pacemaker implantation in our hospital because of third-degree atrioventricular block 6 years ago. At that time, the patient was recommended to have a dual-chamber permanent pacemaker implantation, and finally chose a single-chamber permanent pacemaker because she could not afford the cost. The patient has repeatedly lost consciousness for no obvious reason in the past 3 d, and went to our hospital for treatment. The chest X-ray showed that the pacemaker electrode was broken. After the patient was given a pacemaker electrode replacement, the patient did not continue to lose consciousness.
CONCLUSION Because the electrodes implanted in the subclavian approach are close to the clavicle and the first rib, the pacemaker electrodes may wear out. If the patient loses consciousness again after the pacemaker is implanted, we should consider whether there is a pacemaker. The possibility of electrode breakage, and timely help the patient to replace the new pacemaker electrodes.
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Affiliation(s)
- Xiao-Yong Zhu
- Department of Cardiology, Jiujiang University Affiliated Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Xin-Hu Tang
- Department of Cardiology, Jiujiang University Affiliated Hospital, Jiujiang 332000, Jiangxi Province, China
| | - Wen-Yin Huang
- Department of Cardiology, Jiujiang University Affiliated Hospital, Jiujiang 332000, Jiangxi Province, China
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 1319] [Impact Index Per Article: 439.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Hiruma T, Nagase T, Inoue K, Nitta J, Isobe M. Cephalic vein cut-down technique for severe venous spasm following axillary vein puncture at pacemaker implantation. J Cardiol Cases 2022; 26:245-247. [DOI: 10.1016/j.jccase.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/01/2022] [Accepted: 05/10/2022] [Indexed: 11/15/2022] Open
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Anagnostopoulos I, Kossyvakis C, Kousta M, Verikokkou C, Lakka E, Karakanas A, Deftereos G, Spanou P, Giotaki S, Vrachatis D, Avramidis D, Deftereos S, Giannopoulos G. Different venous approaches for implantation of cardiac electronic devices. A network meta-analysis. Pacing Clin Electrophysiol 2022; 45:717-725. [PMID: 35554947 DOI: 10.1111/pace.14510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Many of the complications arising from cardiac device implantation are associated to the venous access used for lead placement. Previous analyses reported that cephalic vein cutdown (CVC) is safer but less effective than subclavian vein puncture (SVP). However, comparisons between these techniques and axillary vein puncture (AVP) - guided either by ultrasound or fluoroscopy - are lacking. Thus, we aimed to compare safety and efficacy of these approaches. METHODS We searched for articles assessing at least two different approaches regarding the incidence of pneumothorax and/or lead failure (LF). When available, bleeding and infectious complications as well as procedural success were analyzed. A frequentist random effects network meta-analysis model was adopted. RESULTS Thirty-six studies were analyzed. Most articles assessed SVP versus CVC. Compared to SVP, both CVC and AVP were associated with reduced odds of pneumothorax (OR: 0.193, 95%CI: 0.136-0.275 and OR: 0.128, 95%CI: 0.050-0.329; respectively) and LF (OR: 0.63, 95%CI: 0.406-0.976 and OR: 0.425, 95%CI: 0.286-0.632; respectively). No significant differences between AVP and CVC were demonstrated. Limited data suggests no major impact of different approaches on infectious and bleeding complications. Initial CVC approach required significantly more often an alternate/additional venous access for lead placement, compared to both AVP and SVP. No differences between these two were identified. CONCLUSION Both AVP and CVC seem to decrease incident pneumothorax and LF, compared to SVP. Initial AVP approach seems to decrease the need of alternate venous access, compared to CVC. These results suggest that AVP should be further clinically tested.
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Affiliation(s)
| | | | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | | | - Eleni Lakka
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Asterios Karakanas
- 2nd Department of Cardiology, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Gerasimos Deftereos
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Polixeni Spanou
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Sotiria Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Avramidis
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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Editorial Comment to: Perioperative complications after pacemaker implantation: Higher complication rates with subclavian vein puncture than with cephalic vein cut-down (Hasan et al.). J Interv Card Electrophysiol 2022; 66:811-813. [PMID: 35501623 DOI: 10.1007/s10840-022-01221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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Su J, Kusumoto FM, Zhou X, Elayi CS. How to Perform Extrathoracic Venous Access for Cardiac Implantable Electronic Devices Placement: Detailed Description of Techniques. Heart Rhythm 2022; 19:1184-1191. [PMID: 35231611 DOI: 10.1016/j.hrthm.2022.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/02/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Abstract
Venous access is needed for the implantation of cardiac implantable electronic devices (CIED) with endocardial leads. Extrathoracic venous access in the prepectoral region has become the standard of care for CIED implantation because of lower risks for pneumothorax and likely less lead malfunction due to the subclavian crush syndrome. The most common extrathoracic venous access sites in the pectoral region are extrathoracic subclavian vein access, axillary vein access, and cephalic vein access. This review provides a detailed description of the anatomy, technical considerations, and the relative advantages and disadvantages for each of these extrathoracic venous access sites.
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Affiliation(s)
- Jialin Su
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida; Cardiology Service, Berkshire Medical Center, Pittsfield, Massachusetts
| | - Fred M Kusumoto
- Department of Cardiovascular Disease, Mayo Clinic in Florida, Jacksonville, Florida
| | - Xuan Zhou
- Division of Cardiology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Claude S Elayi
- Electrophysiology Service, CHI Saint Joseph Hospital, Lexington, Kentucky.
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30
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Cosgun MS, Cosgun C. Efficacy and safety of different exercises in preventing cardiac implantable electronic device-related shoulder impairment. Pacing Clin Electrophysiol 2022; 45:384-392. [PMID: 35146785 DOI: 10.1111/pace.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/11/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shoulder impairment on the implant-side is common after cardiac implantable electronic device (CIED) implantation. The aim of this study was to compare the efficacy and safety of the pendulum exercise (PE) and stretching & strengthening exercises (SSE) in preventing postimplantation shoulder impairment. METHODS This prospective, randomized study collected data from 89 patients, including 30 in a control group, 31 in a PE group, and 28 in a SSE group. Shoulder functions on the implant-side were evaluated by grip strength (GS), range of motion (ROM), Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and 36-Item Short-Form Survey (SF-36). RESULTS Shoulder median flexion and abduction ROM were significantly improved two-month postimplantation compared to two-week postimplantation in PE (156±11 vs. 146±10, p = .002; 147±9 vs. 136±9, p = .001, respectively) and SSE (158±13 vs. 147±11, p = .003; 149±13 vs. 138±9, p = .002, respectively) groups, but not in the control group. Two months after implantation, the two exercise groups showed no significant differences in any assessment. Compared with the PE and SSE groups, the control group had significantly lower GS (p = .012 and p = .002, respectively) and SF-36 physical component summary (p = .007 and p = .003, respectively) and significantly higher VAS (p = .003 and p = .001, respectively) and QuickDASH (p = .002 and p = .005, respectively) scores two-month postimplantation. CONCLUSIONS PE and SSE for the ipsilateral upper arm starting two-week after CIED implantation provided similar benefits in preserving shoulder girdle muscle strength, maintaining shoulder motion, relieving shoulder pain, preventing shoulder injury, and improving quality of life, without the risk of lead dislodgement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Muharrem Said Cosgun
- Department of Cardiology, Mengucek Gazi Education and Research Hospital, Medical Faculty, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Cansu Cosgun
- Department of Physical Therapy and Rehabilitation, Mengucek Gazi Education and Research Hospital, Medical Faculty, Erzincan Binali Yildirim University, Erzincan, Turkey
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Vascular Accesses in Cardiac Stimulation and Electrophysiology: An Italian Survey Promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing). BIOLOGY 2022; 11:biology11020265. [PMID: 35205131 PMCID: PMC8869488 DOI: 10.3390/biology11020265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022]
Abstract
Simple Summary Both cardiac implantable electronic device (CIED) implantations and electrophysiology procedures require vascular access to reach the heart through vessels. Different types of access carry different rates of complications. Safety and ease of vascular access are the main targets of physicians; in fact, each complication causes morbidity and raises costs. To avoid complications, the use of ultrasound-guided vessel puncture and closure devices is increasing in frequency. We conducted a survey in Italian centers to outline common practice; an uneven pattern of habits emerged. Hopefully, recently published scientific society consensus statements will lead to an improvement in physicians’ practice. The survey highlights that there is an unmet need for dedicated courses, particularly for ultrasound-guided vessel puncture. Abstract Cardiac implantable electronic device (CIED) implants and electrophysiological procedures share a common step: vascular access. On behalf of the AIAC Ricerca Investigators’ Network, we conducted a survey to outline Italian common practice regarding vascular access in EP-lab. All Italian physicians with experience in CIED implantation and electrophysiology were invited to answer an online questionnaire (from May 2020 to November 2020) featuring 20 questions. In total, 103 cardiologists (from 92 Italian hospitals) answered the survey. Vascular access during CIED implants was considered the most complex step following lead placement by 54 (52.4%) respondents and the most complex for 35 (33.9%). In total, 54 (52.4%) and 49 (47.6%) respondents considered the cephalic and subclavian vein the first option, respectively (intrathoracic and extrathoracic subclavian/axillary vein by 22 and 27, respectively). In total, 45 (43.7%) respondents performed close arterial femoral accesses manually; only 12 (11.7%) respondents made extensive use of vascular closure devices. A total of 46 out of 103 respondents had experience in ultrasound-guided vascular accesses, but only 10 (22%) used it for more than 50% of the accesses. In total, 81 (78.6%) respondents wanted to increase their ultrasound-guided vascular access skills. Reducing complications is a goal to reach in cardiac stimulation and electrophysiological procedures. Our survey shows the heterogeneity of the vascular approaches used in Italian centres. Some vascular accesses were proved to be superior to others in terms of complications, with ultrasound-guided puncture as an emerging technique. More effort to produce the standardization of vascular accesses could be made by scientific societies.
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Hasan F, Nedios S, Karosiene Z, Scholten M, Lemke B, Tulka S, Knippschild S, Macher-Heidrich S, Adomeit HJ, Zarse M, Bogossian H. Perioperative complications after pacemaker implantation: higher complication rates with subclavian vein puncture than with cephalic vein cutdown. J Interv Card Electrophysiol 2022; 66:857-863. [PMID: 35107720 PMCID: PMC10172219 DOI: 10.1007/s10840-022-01135-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The cephalic vein cutdown (CVC) and the subclavian puncture (SP) is the most common access for pacemaker implantation. The purpose of this study was to compare the peri-/postoperative complications of these approaches. METHODS A retrospective analysis of the quality assurance data of the state of North Rhine-Westphalia was performed to evaluate the peri-/postoperative complications of first pacemaker implantation according to the venous access. The primary endpoint was defined as the occurrence of one of the following: asystole, ventricular fibrillation, pneumothorax, hemothorax, pericardial effusion, pocket hematoma, lead dislocation, lead dysfunction, postoperative wound infection or other complication requiring intervention. Descriptive analysis was done via absolute, relative frequencies and Odds Ratio. Fisher's exact test was used for comparison of the both study groups. RESULTS From 139,176 pacemaker implantations from 2010 to 2014, 15,483 cases were excluded due to other/double access. The median age was 78 years and the access used was CVC for 75,251 cases (60.8%) and SP for 48,442 cases (39.2%). The implanted devices were mainly dual-chamber pacemakers (73.9% in the CVC group and 78.4% in the SP group), followed by single-chamber pacemakers VVI (24.9% and 19.9% in the CVC and SP group respectively). There were significantly fewer peri/postoperative complications in the CVC group compared to the SP group (2.49% vs. 3.64%, p = 0.0001, OR 1.47; 95% CI 1.38-1.57). CONCLUSIONS CVC as venous access for pacemaker implantation has significantly fewer peri/postoperative complications than SP and appears to be an advantageous technique.
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Affiliation(s)
- Fuad Hasan
- Department of Cardiology, Elektrophysiology, and Angiology, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515, Lüdenscheid, Germany. .,University Witten/Herdecke, Witten, Germany.
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Zana Karosiene
- Department of Cardiology, Elektrophysiology, and Angiology, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515, Lüdenscheid, Germany
| | - Marvin Scholten
- Department of Cardiology, Elektrophysiology, and Angiology, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515, Lüdenscheid, Germany.,University Witten/Herdecke, Witten, Germany
| | - Bernd Lemke
- Department of Cardiology, Elektrophysiology, and Angiology, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515, Lüdenscheid, Germany
| | - Sabrina Tulka
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, Witten, Germany
| | - Stephanie Knippschild
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, Witten, Germany
| | | | | | - Markus Zarse
- Department of Cardiology, Elektrophysiology, and Angiology, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515, Lüdenscheid, Germany.,University Witten/Herdecke, Witten, Germany
| | - Harilaos Bogossian
- University Witten/Herdecke, Witten, Germany.,Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Hagen, Germany
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Davis L, Chik W, Kumar S, Sivagangabalan G, Thomas SP, Denniss AR. Axillary vein access using ultrasound guidance, Venography or Cephalic Cutdown-What is the optimal access technique for insertion of pacing leads? J Arrhythm 2021; 37:1506-1511. [PMID: 34887955 PMCID: PMC8637085 DOI: 10.1002/joa3.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
We reviewed the different approaches used for central vein access during insertion of cardiac implantable electronic devices. The benefits and hazards of each approach (cephalic vein cutdown, axillary vein cannulation using venography and ultrasound) are discussed. Each approach has its advantages and hazards that need to be considered for the individual patient and balanced against the skills of the operator. The benefits of ultrasound guided venous access in reducing radiation exposure to the patient and implanter, avoiding the need for angiographic contrast and in minimizing the risk of pneumothorax and inadvertent arterial puncture are highlighted. Trainees should be taught each approach to deal with patient variability. Ultrasound guidance should be considered as a mainstream option for most patients.
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Affiliation(s)
- Lloyd Davis
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- Westmead Private HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - William Chik
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- Westmead Private HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
- The University of Notre DameSydneyNew South WalesAustralia
| | - Saurabh Kumar
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- Westmead Private HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Gopal Sivagangabalan
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- Westmead Private HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
- The University of Notre DameSydneyNew South WalesAustralia
| | - Stuart P. Thomas
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- Westmead Private HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - A. Robert Denniss
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
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Taleski J, Stankovik S, Risteski D, Janusevski F, Pocesta B, Zimbakov Z, Poposka L. Sex-related differences regarding cephalic vein lead access for CIEDs implantation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2021. [DOI: 10.1186/s42444-021-00049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Minimally invasive and safe central venous access is imperative for lead insertion of cardiac implantable electronic devices (CIEDs). The purpose of this trial was to explore and compare the usability of the cephalic vein (CV) between both sexes.
Methods and results
This single-center prospective study included 102 consecutive patients in a period of six months. Pre-procedural contrast-enhanced venographic images of the upper arm were performed in all included patients. Our attention was focused on comparing several morpho-anatomical CV characteristics such as venous diameter, presence of valves and angle of entrance of the CV into the subclavian vein (SV). Study results concerning the CV morpho-anatomical differences were more favorable regarding the female patient group, with significant differences in CV diameter (p-0.030). There was also a difference in favor of the female group regarding the favorable CV angle of entrance into the SV, found in the 61.7% versus 54.4% in the male patient group. The comparison of usability of the CV and CVC technique was explored by comparing the number of leads inserted through the CV in both sexes. Two leads were implanted in 11.7% in the female group versus 5.8% in the male group, and 0 leads through the CV in 38.2% of the female patients versus 50% of male group.
Conclusion
Female patients have more favorable cephalic vein morpho-anatomical futures and better usability for lead placement than male patients.
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Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
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Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
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The Natural History and Treatment of Cardiac Implantable Electronic Device Associated Pneumothorax-A 10-Year Single-Centre Experience. CJC Open 2021; 3:176-181. [PMID: 33644731 PMCID: PMC7893186 DOI: 10.1016/j.cjco.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022] Open
Abstract
Background Pneumothorax is a common complication of cardiac implantable electronic device (CIED) procedures. There is a paucity of data on the natural history and management of a CIED-associated pneumothorax. Methods This is a single-centre retrospective study of all consecutive patients with a CIED-associated pneumothorax between March 2010 and March 2020. Pneumothorax size was determined on all chest x-rays after device implantation and before chest tube insertion (if placed). Changes in pneumothorax size on serial chest x-rays were reported. Clinical outcomes in patients with a severe-sized pneumothorax treated with a chest tube were compared with those treated conservatively. Results A total of 86 CIED-associated pneumothoraxes were identified, with 55 (63.9%) patients having a pneumothorax severe in size. Thirty-seven patients with a severe pneumothorax received a chest tube, whereas 18 were managed conservatively. Chest tube use was associated with a higher rate of admission to hospital (100% vs 63%, P = 0.02) for patients undergoing outpatient procedure, longer length of stay (6.3 ± 3.9 vs 2.7 ± 2.9 days, P = 0.04), but fewer chest x-rays (1.9 ± 0.7 vs 4.1 ± 2.5, P = 0.002). Conclusion An initial strategy of conservative management of a CIED-associated pneumothorax in select patients may be feasible and safe.
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Rademakers LM, Bracke FA. Cephalic vein access by modified Seldinger technique for lead implantations. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:607-613. [PMID: 33609409 DOI: 10.1111/pace.14200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Venous access for cardiac implantable electronic devices (CIED) is commonly performed by cephalic venous cut down, or axillary or subclavian vein puncture. The latter technique carries a risk of complications such as pneumothorax or lead crush. Cephalic venous cut down is free of these complications but often less successful due to technical difficulties. We report a highly successful, simplified cephalic venous access with a modified Seldinger technique. METHODS We prospectively studied 221 patients undergoing de novo implantation of a one, two, or three lead device system performed over a 1-year period at our center, and assessed the efficacy of the cephalic vein access including the number of leads successfully placed for each procedure. RESULTS In 83% of patients undergoing CIED implantation, a suitable cephalic vein was present. In respectively 98% and 99% of patients undergoing single- or dual-chamber CIED implantation, lead placement could be performed exclusively via the cephalic vein and in 72% of cardiac resynchronization therapy implants, all three leads were placed via cephalic access. CONCLUSION A novel, technically simple cephalic venous catheterization technique provides high success rates for any CIED lead implantation.
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Affiliation(s)
| | - Frank A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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Taleski J, Zafirovska B. Strategies to Promote Long-Term Cardiac Implant Site Health. Cureus 2021; 13:e12457. [PMID: 33552775 PMCID: PMC7854325 DOI: 10.7759/cureus.12457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 12/15/2022] Open
Abstract
In the past several decades there has been a continuous growth in the field of cardiac implantable electronic devices (CIED) implantation procedures as well as their technological development. CIEDs utilize transvenous leads that are introduced into the heart via the axillary, subclavian, or cephalic veins, as well as a devices generator that is implanted in a subcutaneous pocket, typically in the pre-pectoral region. Despite this significant improvement, complication rates range from 1-6% with current implant tools and techniques. In this review we will discuss the three central parts of the CIED implantation procedure, their impact on implantation site, infections, and possibilities for its prevention.
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Affiliation(s)
- Jane Taleski
- Electrophysiology and Electrostimulation, University Clinic of Cardiology, Skopje, MKD
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Ho K, Patel R, Dehghani P. Deployment of a Covered Stent for Left Internal Mammary Perforation From Percutaneous Pacemaker Implantation. CJC Open 2020; 2:708-710. [PMID: 33305234 PMCID: PMC7710994 DOI: 10.1016/j.cjco.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/28/2020] [Indexed: 11/21/2022] Open
Abstract
A 79-year-old woman developed a hemothorax 2 days after implantation of a permanent pacemaker. Computed tomography angiography revealed active extravasation from the left internal mammary artery. A covered stent was deployed to manage the arterial perforation. This case report explores different venous access techniques to minimize the risk of arterial injuries and describes the use of a covered stent in managing a non-grafted left internal mammary artery injury from a pacemaker implantation procedure.
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Affiliation(s)
- Karen Ho
- Division of Internal Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Rajesh Patel
- Department of Medical Imaging, Reginal Qu’Appelle Health Region, Saskatchewan, Canada
| | - Payam Dehghani
- Division of Internal Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Section of Cardiology, Department of Internal Medicine, Regina General Hospital, Regina, Saskatchewan, Canada
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40
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Maass AH, Groenveld HF, Rienstra M. Do not yet abandon cephalic vein access for multiple leads in ICD implantation. J Cardiovasc Electrophysiol 2020; 31:2788. [PMID: 32767614 DOI: 10.1111/jce.14702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hessel F Groenveld
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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