title: Axillary versus infraclavicular placement for endocardial heart rhythm devices in patients with pediatric and congenital heart disease.
abstract: Our objective was to evaluate the implant and mid-term outcomes of transvenous pacemaker or internal cardioverter-defibrillator placement by alternative axillary approaches compared to the infraclavicular approach in a pediatric and congenital heart disease population. We conducted a retrospective review of all patients with new endocardial heart rhythm devices placed at 4 pediatric arrhythmia centers. A total of 317 patients were included, 63 had undergone a 2-incision axillary approach, 51 a retropectoral axillary approach, and 203 an infraclavicular approach. Congenital heart disease was present in 62% of the patients. The patients with the 2-incision axillary approach were younger and smaller. The patients with the retropectoral axillary approach were less likely to have undergone previous cardiac surgery and were more likely to have had an internal cardioverter-defibrillator placed. The duration of follow-up was 2.4 ± 1.9 years for the 2-incision axillary, 2.6 ± 2.6 years for retropectoral axillary, and 3.5 ± 1.4 years for the infraclavicular technique (p = 0.01). No differences were seen in implant characteristics, lead longevity, implant complications, lead fractures or dislodgements, inappropriate internal cardioverter-defibrillator discharges, or device infections among the 3 groups. In conclusion, our data support that the outcomes of axillary approaches are comparable to the infraclavicular approach for endocardial heart rhythm device placement and that axillary approaches should be considered a viable option in patients with pediatric and congenital heart disease.
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital, University of Colorado, Denver, Colorado, USA. rausch.christopher@tchden.org
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Rausch
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Hughes
authors.forename: Martin
authors.initials: M
authors.lastname: Runciman
authors.forename: Ian H
authors.initials: IH
authors.lastname: Law
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.forename: Mathur
authors.initials: M
authors.lastname: Sujeev
authors.forename: Abdul
authors.initials: A
authors.lastname: Duke
authors.forename: Michael
authors.initials: M
authors.lastname: Schaffer
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D001365:Axilla; D002968:Clavicle; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult