title: Percutaneous axillary vein approach in pediatric pacing: comparison with subclavian vein approach.
abstract: OBJECTIVE
  The subclavian vein approach has been used for 20 years in our center for pacemaker (PM) implantation in children, but it carries risks of hemothorax/pneumothorax and lead fracture, which could be reduced by axillary vein approach.
  
  
  RESULTS
  This is a prospective study enrolling the first 48 consecutive pediatric patients (age: 12.3 ± 4.6 years) who underwent PM/implantable cardioverter-defibrillator leads implantation through axillary vein (guided by contrast venography) between 2009 and 2012 (group I). A comparison was made with the outcomes of the subclavian vein approach (group II) in 41 patients, age 12.3 ± 4.8 years, consecutively enrolled between 2006 and 2011. The two groups showed no significant differences for the variables examined except for follow-up, longer in group II, and for alternative ventricular pacing sites, more frequent in group I. Axillary vein diameter was 7.9 ± 1.7 mm and showed positive correlation with height (r = 0.77). The axillary vein approach was effective in 93.7% of patients. The unsuccessful procedures occurred in patients with significantly lower age and smaller venous diameters. The subclavian vein approach was effective in 100% of patients. Sixty-two leads were implanted in group I, 54 in group II. There were neither intraoperative complications in both the groups, nor significant differences for early and late complications.
  
  
  CONCLUSIONS
  The axillary vein approach for PM implantation in children is effective and safe for physicians skilled with subclavian vein approach. Younger patients with smaller vein diameters are at low risk for unsuccessful procedure.
authors.affiliation: Arrhythmology Unit and Syncope Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Massimo Stefano
authors.initials: MS
authors.lastname: Silvetti
authors.forename: Silvia
authors.initials: S
authors.lastname: Placidi
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Palmieri
authors.forename: Daniela
authors.initials: D
authors.lastname: Righi
authors.forename: Lucilla
authors.initials: L
authors.lastname: Ravà
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D001367:Axillary Vein / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D015984:Causality; D002648:Child; D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D018570:Risk Assessment; D013350:Subclavian Vein / Q000601:surgery*; D016896:Treatment Outcome
keywords: cardiac pacing; children; congenital heart defect; pacing complication; transvenous pacing