Prospective randomized comparison of the safety and effectiveness of placement of endocardial pacemaker and defibrillator leads using the extrathoracic subclavian vein guided by contrast venography versus the cephalic approach

Hugh Calkins, Brian M. Ramza, Jeffrey Brinker, Water Atiga, Kevin Donahue, Emmanuel Nsah, Eric Taylor, Henry Halperin, John H. Lawrence, Gordon F. Tomaselli, Ronald D. Berger

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

The purpose of this prospective randomized study was to compare the safety and efficacy of the cephalic approach versus a contrast-guided extrathoracic approach for placement of endocardial leads. Despite an increased incidence of lead fracture, the intrathoracic subclavian approach remains the dominant approach for placement of pacemaker and implantable defibrillator leads. Although this complication can be prevented by lead placement in the cephalic vein or by lead placement in the extrathoracic subclavian or axillary vein, these approaches have not gained acceptance. A total of 200 patients were randomized to undergo placement of pacemaker or implantable defibrillator leads via the contrast-guided extrathoracic subclavian vein approach or the cephalic approach. Lead placement was accomplished in 99 of the 100 patients randomized to the extrathoracic subclavian vein approach as compared to 64 of 100 patients using the cephalic approach. In addition to a higher initial success rate, the extrathoracic subclavian vein medial approach was determined to be preferable as evidenced by a shorter procedure time and less blood loss. There was no difference in the incidence of complications. In conclusion, these results demonstrate that lead placement in the extrathoracic subclavian vein guided by contrast venography is effective and safe. It was also associated with no increased risk of complications as compared with the cephalic approach. These findings suggest that the contrast-guided approach to the extrathoracic portion of the subclavian vein should be considered as an alternative to the cephalic approach.

Original languageEnglish (US)
Pages (from-to)456-464
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume24
Issue number4 I
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

Fingerprint

Subclavian Vein
Defibrillators
Phlebography
Head
Safety
Implantable Defibrillators
Axillary Vein
Incidence
Veins
Prospective Studies
Lead

Keywords

  • Endocardial lead
  • Implantable defibrillator
  • Pacemaker
  • Subclavian vein

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prospective randomized comparison of the safety and effectiveness of placement of endocardial pacemaker and defibrillator leads using the extrathoracic subclavian vein guided by contrast venography versus the cephalic approach. / Calkins, Hugh; Ramza, Brian M.; Brinker, Jeffrey; Atiga, Water; Donahue, Kevin; Nsah, Emmanuel; Taylor, Eric; Halperin, Henry; Lawrence, John H.; Tomaselli, Gordon F.; Berger, Ronald D.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 24, No. 4 I, 01.01.2001, p. 456-464.

Research output: Contribution to journalArticle

Calkins, Hugh ; Ramza, Brian M. ; Brinker, Jeffrey ; Atiga, Water ; Donahue, Kevin ; Nsah, Emmanuel ; Taylor, Eric ; Halperin, Henry ; Lawrence, John H. ; Tomaselli, Gordon F. ; Berger, Ronald D. / Prospective randomized comparison of the safety and effectiveness of placement of endocardial pacemaker and defibrillator leads using the extrathoracic subclavian vein guided by contrast venography versus the cephalic approach. In: PACE - Pacing and Clinical Electrophysiology. 2001 ; Vol. 24, No. 4 I. pp. 456-464.
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AU - Brinker, Jeffrey

AU - Atiga, Water

AU - Donahue, Kevin

AU - Nsah, Emmanuel

AU - Taylor, Eric

AU - Halperin, Henry

AU - Lawrence, John H.

AU - Tomaselli, Gordon F.

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AB - The purpose of this prospective randomized study was to compare the safety and efficacy of the cephalic approach versus a contrast-guided extrathoracic approach for placement of endocardial leads. Despite an increased incidence of lead fracture, the intrathoracic subclavian approach remains the dominant approach for placement of pacemaker and implantable defibrillator leads. Although this complication can be prevented by lead placement in the cephalic vein or by lead placement in the extrathoracic subclavian or axillary vein, these approaches have not gained acceptance. A total of 200 patients were randomized to undergo placement of pacemaker or implantable defibrillator leads via the contrast-guided extrathoracic subclavian vein approach or the cephalic approach. Lead placement was accomplished in 99 of the 100 patients randomized to the extrathoracic subclavian vein approach as compared to 64 of 100 patients using the cephalic approach. In addition to a higher initial success rate, the extrathoracic subclavian vein medial approach was determined to be preferable as evidenced by a shorter procedure time and less blood loss. There was no difference in the incidence of complications. In conclusion, these results demonstrate that lead placement in the extrathoracic subclavian vein guided by contrast venography is effective and safe. It was also associated with no increased risk of complications as compared with the cephalic approach. These findings suggest that the contrast-guided approach to the extrathoracic portion of the subclavian vein should be considered as an alternative to the cephalic approach.

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