Prevalence of central venous occlusion in patients with chronic defibrillator leads.
BACKGROUND
Many patients with previously implanted ventricular defibrillators are candidates for an upgrade to a device capable of atrial-ventricular sequential or multisite pacing. The prevalence of venous occlusion after placement of transvenous defibrillator leads is unknown. The purpose of this study was to determine the prevalence of central venous occlusion in asymptomatic patients with chronic transvenous defibrillator leads.


METHODS
Thirty consecutive patients with a transvenous defibrillator lead underwent bilateral contrast venography of the cephalic, axillary, subclavian, and brachiocephalic veins as well as the superior vena cava before an elective defibrillator battery replacement. The mean time between transvenous defibrillator lead implantation and venography was 45 +/- 21 months. Sixteen patients had more than 1 lead in the same subclavian vein. No patient had clinical signs of venous occlusion.


RESULTS
One (3%) patient had a complete occlusion of the subclavian vein, 1 (3%) patient had a 90% subclavian vein stenosis, 2 (7%) patients had a 75% to 89% subclavian stenosis, 11 (37%) patients had a 50% to 74% subclavian stenosis, and 15 (50%) patients had no subclavian stenosis.


CONCLUSIONS
The low prevalence of subclavian vein occlusion or severe stenosis among defibrillator recipients found in this study suggests that the placement of additional transvenous leads in a patient who already has a ventricular defibrillator is feasible in a high percentage of patients (93%).
Sticherling
C
C
Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 49109-0022, USA.
Chough
S P
SP
Baker
R L
RL
Wasmer
K
K
Oral
H
H
Tada
H
H
Horwood
L
L
Kim
M H
MH
Pelosi
F
F
Michaud
G F
GF
Strickberger
S A
SA
Morady
F
F
Knight
B P
BP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001367:Axillary Vein / Q000000981:diagnostic imaging; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D003251:Constriction, Pathologic; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000628:therapy; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology