Author + information
- Received September 9, 2019
- Revision received December 20, 2019
- Accepted January 23, 2020
- Published online March 16, 2020.
- Varunsiri Atti, MDa,∗,
- Mohit K. Turagam, MDb,∗∗ (, )@mohitkturagam,
- Jalaj Garg, MDc,
- Scott Koerber, MDd,
- Aakash Angirekulae,
- Rakesh Gopinathannair, MDd,
- Andrea Natale, MDf and
- Dhanunjaya Lakkireddy, MDd
- aDepartment of Medicine, Michigan State University–Sparrow Hospital, East Lansing, Michigan
- bDepartment of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- cDivision of Cardiovascular Medicine, Medical College Wisconsin, Milwaukee, Wisconsin
- dKansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas
- eMedical Center Hospital, Odessa, Texas
- fTexas Cardiac Arrhythmia Institute, Austin, Texas
- ↵∗Address for correspondence:
Dr. Mohit K. Turagam, Helmsley Electrophysiology Center, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029.
Objectives This study sought to evaluate the efficacy and safety of venous access techniques for cardiac implantable electronic device (CIED) implantation.
Background Minimally invasive transvenous access is a fundamental step during implantation of CIEDs. However, the preferred venous access is still subject to ongoing debate, and the decision depends on patient characteristics and operator experience.
Methods A comprehensive search for studies comparing subclavian vein puncture (SVP) and axillary vein puncture (AVP) versus cephalic vein cutdown (CVC) for CIED implantation was performed in PubMed, Google Scholar, EMBASE, SCOPUS, ClinicalTrials.gov, and various scientific conferences from inception to July 1, 2019. A meta-analysis was performed by using a random effects model to calculate risk ratios (RRs) and mean differences with 95% confidence interval (CIs).
Results Twenty-three studies were eligible that included 35,722 patients (SVP, 18,009 patients; AVP, 409 patients; and CVC, 17,304 patients). Compared with CVC, SVP was associated with a higher risk of pneumothorax (RR: 4.88; 95% CI: 2.95 to 8.06) and device/lead failure (RR: 2.09; 95% CI: 1.07 to 4.09), whereas there was no significant difference in these outcomes compared with AVP. Acute procedural success was significantly higher with SVP compared with CVC (RR: 1.24; 95% CI: 1.00 to 1.53). There was no significant difference in other complications such as pocket hematoma/bleeding, device infection, or pericardial effusion between SVP or AVP compared with CVC.
Conclusions CVC was associated with a lower risk of pneumothorax and lead failure compared with SVP. AVP and CVC are both effective approaches for CIED lead implantation and offer the potential to avoid the complications usually observed with traditional SVP.
- axillary vein puncture
- cardiac implantable electronic device
- cephalic vein cutdown
- lead implantation
- subclavian vein puncture
↵∗ Drs. Atti and Turagam contributed equally to this work and are joint first authors.
No external sources of funding have been utilized for this systematic review and meta-analysis. Dr. Natale has served as a consultant for Biosense Webster, Medtronic, Biotronik, St. Jude/Abbott, Baylis, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 9, 2019.
- Revision received December 20, 2019.
- Accepted January 23, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.