Clinical experience of contrast venography guided axillary vein puncture in biventricular pacing.
Biventricular pacing is a new modality of treatment for patients with drug-refractory heart failure and ECG evidence of dyssynchronous ventricular contraction. A third lead is required to be placed in a coronary vein through the coronary sinus for left ventricular pacing, in addition to the atrial and right ventricular leads. Subclavian crush phenomenon is associated with lead placement using subclavian puncture. Cephalic venous cutdown, free of this complication, provides vascular access which is probably too small for multiple leads placement in biventricular pacing. Contrast venography guided axillary vein puncture (AP) is an alternative approach. This study reports on clinical experience of this technique in biventricular pacing.



AP is the method of choice for biventricular pacing in Princess Margaret Hospital and Stanford University Medical Center. Patients' clinical characteristics, effectiveness and safety of the technique were analysed.



AP was performed in 35 patients, 29 male and six female with mean age 57.1 +/- 14.7 years from 1 January 2000 to 30 June 2001. Six patients had biventricular pacing alone and 29 patients had biventricular implantable cardioverter defibrillator (ICD) implanted. Twelve (34.3%) patients have ischaemic cardiomyopathy, 22 (62.9%) patients have dilated cardiomyopathy and one (2.9%) patient has hypertrophic cardiomyopathy. Six (17.1%) patients were in NYHA Class II heart failure, 21 (60.0%) patients were in Class III and eight (22.9%) patients were in Class IV. The mean EF was 23.1 +/- 7.6%. AP was attempted for placement of all three leads in all patients. AP was successful in 34 (97.1%) patients. The single failure was due to small size of the axillary vein. There were no AP, lead or contrast-related complications with a follow up of 12 months.



AP is both effective and safe for biventricular pacing. It may be the method of choice in biventricular pacing.
Chan
Ngai-Yin
NY
Cardiology Team, Department of Medicine & Geriatrics, Princess Margaret Hospital, Princess Margaret Hospital Road, Kowloon, Hong Kong, Hong Kong. nywfchan@netvigator.com
Liem
L Bing
LB
Mok
Ngai-Shing
NS
Wong
W
W
D000328:Adult; D000368:Aged; D001367:Axillary Vein / Q000000981:diagnostic imaging; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000628:therapy*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008875:Middle Aged; D010690:Phlebography / Q000379:methods