Author + information
- D. Cozma,
- C. Vacarescu,
- L. Petrescu and
- E.V. Goanta
outcome of single venous approach using direct percutaneous subclavian vein (DPSV) puncture, without initial incision, for CRT device implantation as a hypothesis for saving time and x-ray exposure.
a retrospective study which included patients (pts) implanted with CRT-P/CRT-D devices using only DPSV puncture, without intial incision. We analyzed the outcome regarding the procedure related difficulties and complications.
72 pts (48 male) aged 60±11 y.o. were included (46 pts with CRT-P, 26 pts CRT-D). Intraprocedural difficulties and complications: total AV block (2 pts) and unsuccessful LV lead placement (6 pts). Post implantation: no pneumothorax or lead displacement cases to report. Follow-up 26±18 months: 1 pt (CRT-D device) developed pocket infection 4 months after mixed approach (epicardial LV and endovenous RA and RV lead implantation); device removal and lead extraction were performed. No other complications were noted in long term follow-up.
|Intraprocedural difficulties and complications|
|AV block during implantation (during sheath manipulation)||Action required - initial transitory RV catheter stimulation||2 pts (3%)|
|Unsuccessful LV lead placement due to CS anatomy||The procedure was aborted, all materials were withdrawn and the pts were addressed for epicardial LV placement using minithoracotomy, with subsequent CRT device implantation using DPSV puncture for RV and RA leads.||6 pts (8%)|
|Average implantation time||65 ± 25 min|
|Average fluoroscopic time||12 ± 9 min|
|Average incision time||24 ± 8 min|
|Pocket infection||Device removal and lead extraction were performed.||1 pt (1%)|
Our data showed valuable incision time and x-ray exposure reduction and a relatively low rate of occurrence of intraprocedure total AV block, without other complications requiring the implantation of the RV lead first.