Lower incidence of venous thrombosis with temporary active-fixation lead implantation in mobile patients.
OBJECTIVE
Temporary transfemoral cardiac pacing is widely accepted, but is associated with high incidence of asymptomatic deep vein thrombosis (DVT), which in turn is associated with restricted patient mobility. The passive-fixation lead typically used in this procedure restricts patient mobility during implantation.


RESULTS
An active-fixation lead allowing normal ambulation was prospectively assessed in 47 consecutive patients. Prior to explantation, venous duplex ultrasound was performed to determine DVT incidence, with the contralateral leg as control. To reduce possible false negatives, ventilation/perfusion scintigraphy was also performed (n = 42). Patient mobility during implantation was classified as high (n = 29), moderate (n = 6), or low (n = 12). Anticoagulants were limited to cases meeting standard guidelines. Asymptomatic DVT was diagnosed in three patients (6.4%), compared with 25-39% reported using standard passive-fixation leads. Furthermore, all of these patients had low mobility during the implantation period. No post-implantation lung scan showed high probability of pulmonary embolism.


CONCLUSIONS
In the 75% of patients with moderate or high mobility, there were no DVT cases. The 6.4% DVT incidence was limited to patients with low mobility and was significantly lower than the norm for this procedure. A larger, randomized study is needed to confirm the benefits of the mobility allowed by an active-fixation lead.
García Guerrero
Juan J
JJ
Department of Cardiology, Hospital Infanta Cristina, Ctra. Portugal S/N, Badajoz 06080, Spain. juanjose.garcia@ya.com
Fernández de la Concha Castañeda
Joaquín
J
López Quero
Domingo
D
Collado Bueno
Gabriel
G
Infante de la Torre
José R
JR
Rayo Madrid
Juan I
JI
Redondo Méndez
Angel
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D054537:Atrioventricular Block / Q000601:surgery; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D015994:Incidence; D007866:Leg / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
D000925:Anticoagulants