PERMANENT PACE MAKER IMPLANTATION THROUGH AXILLARY VEIN APPROCH

Authors

Abstract

Background: Device implantation is an integral part of interventional cardiology particularly electrophysiology. In this study, we are going to shear our experience of device implantation technique at electrophysiology department Hayatabad Medical Complex, Peshawar. Methods: the study was conducted from June 2011 to December 2015. Axillary vein was used to implant the devices but in some cases when this rout was not convenient due to any reason then subclavian vein was entered through the Seldinger technique. Fluoroscopy time was less than 10 minutes and total procedure time was not more than 45 minutes. Electric cautery was used only in two cases. Pressure dressing was used in a few cases. Results: Total numbers of permanent pacemakers (PPM) remain 800 during the study period. There were 450 single chamber pacemakers and 350 dual chambers pacemakers. No case of any major bleeding was documented and in very few cases there was mild ooze from the procedure site after the operation which was tackled with pressure dressing. Four cases of pneumothorax were noted during the study period and in three cases chest intubation were done and one patient was kept on conservative management. Patient were followed after one moth of discharge from the hospital and then yearly. Eight cases of lead dislodgment were documented during the study period. Conclusion: Axillary vein approach for implantation of permanent pacemakers is a safe and less time-consuming technique.Keywords: Axillary vein; Permanent pacemakers (PPM); Seldinger technique; Subclavian vein

Author Biography

Bakhawar Shah, Hayat Abad Medical Complex Peshawar

cardiology

References

Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;51(21):e1–62.

Kabir MS, Islam MN, Ahmed AK, Matin MA, Barkatullah MA, Rahman MM. Outcome of Different Invasive Procedures in the Department of Cardiology, Dinajpur Medical College Hospital. Dinajpur Med Col J 2012;5(1):7–10.

Sarveswaran J, Burke D, Bodenham A. Cephalic vein cut-down verses percutaneous access: a retrospective study of complications of implantable venous access devices. Am J Surg 2007;194(5):699.

Tse HF, Lau CP, Leung SK. A cephalic vein cut down and venography technique to facilitate pacemaker and defibrillator lead implantation. Pacing Clin Electrophysiol 2001;24(4 Pt 1):469–73.

Chen JY, Chang KC, Lin YC, Chou HT, Hung JS. Pre-procedure duplex ultrasonography to assist cephalic vein isolation in pacemaker and defibrillator implantation. J Interv Card Electrophysiol 2005;12(1):75–81.

Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286(6):700–7.

Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med 1986;146(2):259–61.

McWilliams MJ, Civello KC, Chung MK, Saliba WI, Wilkoff BL. Axillary vein puncture access causes a unique lead failure mechanism. Heart Rhythm 2005;2(5 Suppl):S242.

Dora SK, Kumar VK, Bhat A, Tharakan JA. Venogram-guided extra thoracic subclavian vein puncture. Indian Heart J 2003;55(6):637–40.

Beck H, Boden WE, Patibandla S, Kireyev D, Gutpa V, Campagna F, et al. 50th Anniversary of the first successful permanent pacemaker implantation in the United States: historical review and future directions. Am J Cardiol 2010;106(6):810–8.

Lagergren H. How it happened: my recollection of early pacing. Pacing Clin Electrophysiol 1978;1(1):140–3.

Aquilina O. A brief history of cardiac pacing. Images Paediatr Cardiol 2006;8(2):17–81.

Kantrowitz A, Cohen R, Raillard H, Schmidt J, Feldman DS. The treatment of complete heart block with an implanted, controllable pacemaker. Surg Gynecol Obstet 1962;115:415–20.

Hyman A. Resuscitation of the stopped heart by intracardial therapy: II. Experimental use of an artificial pacemaker. Arch Intern Med 1932;50(2):283–305.

Larsson B, Elmqvist H, Ryden L, Schuller H. Lessons from the first patient with an implanted pacemaker: 1958–2001. Pacing Clin Electrophysiol 2003;26(1 Pt 1):114–24.

Harthorne JW. Programmable pacemakers: technical features and clinical applications. Cardiovasc Clin 1983;14(2):135–47.

Ayadi S, Ksantini R, Maghrebi H, Daghfous A, Ayadi M, Fteriche F, et al. Totally implantable venous access ports by cephalic vein cut-down for patients receiving chemotherapy. Tunis Med 2011;89(8-9):699–702.

Ussen B, Dhillon PS, Anderson L, Beeton I, Hickman M, Gallagher MM. Safety and feasibility of cephalic venous access for cardiac resynchronization device implantation. Pacing Clin Electrophysiol 2011;34(3):365–9.

Chang HM, Hsieh CB, Hsieh HF, Chen TW, Chen CJ, Chan DC, et al. An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases. Eur J Surg Oncol 2006;32(1):90–3.

Ramza BM, Rosenthal L, Hui R, Nsah E, Savader S, Lawrence JH, et al. Safety and effectiveness of placement of pacemaker and defibrillator leads in the axillary vein guided by contrast venography. Am J Cardiol 1997;80(7):892–6.

Magney JE, Flynn DM, Parsons JA, Staplin DH, Chin-Purcell MV, Milstein S, et al. Anatomical mechanisms explaining damage to pacemaker leads, defibrillator leads, and failure of central venous catheters adjacent to the sternoclavicular joint. Pacing Clin Electrophysiol 1993;16(3 Pt 1):445–57.

Roelke M, O'Nunain SS, Osswald S, Garan H, Harthorne JW, Ruskin JN. Subclavian crush syndrome complicating transvenous cardioverter defibrillator systems. Pacing Clin Electrophysiol 1995;18(5 Pt 1):973–9.

Langer K. On the anatomy and physiology of the skin: I. the cleavability of the cutis. Br J Plast Surg 1978;31(1):3–8.

Antonelli D, Feldman A, Freedberg NA, Turgeman Y. Axillary vein puncture without contrast venography for pacemaker and defibrillator leads implantation. Pacing Clin Electrophysiol 2013;36(9):1107–10.

Published

2017-04-08

Most read articles by the same author(s)

<< < 1 2