Implantation of cardiac resynchronization therapy devices using three leads by cephalic vein dissection approach.
OBJECTIVE
Percutaneous subclavian, axillary, and cephalic vein access are all used in conjunction for atrial and ventricular lead implantation, though no standard approach for cardiac resynchronization therapy (CRT) device implantation has been established. We describe an effective and a safe technique for implanting three leads via cephalic vein for CRT pacemaker and/or defibrillator implantations.


RESULTS
A total of 171 consecutive patients undergoing de novo implantation of CRT pacemaker or defibrillator were included. Cephalic vein access was achieved by dissection and direct visualization. If the cephalic vein was inadequate, alternate means of access was determined after outset of the procedure. Procedural success rates and complications were recorded. Of the 171 de novo CRT implant attempts, 169 (98.8%) patients had successful implantation of all 3 leads on the first attempt. Of the 171 procedural attempts, 150 (87.7%) patients had all 3 leads placed via cephalic vein. Overall, complications occurred in 6 of 171 patients (3.5%) including initial and repeat procedures. These complications included seven lead dislodgements, two cases of diaphragmatic stimulation requiring lead revision, and one coronary sinus dissection without pericardial effusion. There were no cases of pneumothorax, pocket haematoma requiring evacuation, or infection.


CONCLUSIONS
The triple lead via cephalic vein technique is safe and effective when used as a first approach for CRT device implantation.
McGill University Health Centre, 1650 Cedar Avenue, Room E5-200, Montreal, Quebec H3G 1A4, Canada.
Alexios
A
Hadjis
Cardiology Department, Luigi Sacco Hospital, Milan, Italy.
Riccardo
R
Proietti
McGill University Health Centre, 1650 Cedar Avenue, Room E5-200, Montreal, Quebec H3G 1A4, Canada.|Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
Vidal
V
Essebag
D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D017147:Defibrillators, Implantable; D004210:Dissection / Q000009:adverse effects; D004554:Electric Countershock / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery*
Biventricular pacing; Cardiac resynchronization therapy; Cephalic vein; Defibrillator; Pacemaker; Techniques