Do not yet abandon cephalic vein access for multiple leads in ICD implantation

Maass, Alexander H.; Groenveld, Hessel F.; Rienstra, Michiel

doi:10.1111/jce.14702

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…We believe that many small technical 11 and methodological differences could play a role in lead durability: for example, our policy is to place all leads via peel‐away sheaths to protect the tip from stress produced by passage through a tortuous cephalic vein. In our series, 75% of the operators would be considered as “cephalic‐operators” with a similar well‐honed technique and experience in accessing this vein, maintaining consistency, and minimizing error.…”

Section: Discussionmentioning

confidence: 99%

Multi‐lead cephalic venous access and long‐term performance of high‐voltage leads

Akhtar

Harding

Elbatran

et al. 2021

Cardiovasc electrophysiol

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Background Cardiac resynchronization therapy‐defibrillator (CRT‐D) implantation via the cephalic vein is feasible and safe. Recent evidence has suggested a higher implantable cardioverter‐defibrillator (ICD) lead failure in multi‐lead defibrillator therapy via the cephalic route. We evaluated the relationship between CRT‐D implantation via the cephalic and ICD lead failure. Methods Data was collected from three CRT‐D implanting centers between October 2008 and September 2017. In total 633 patients were included. Patient and lead characteristics with ICD lead failure were recorded. Comparison of “cephalic” (ICD lead via cephalic) versus “non‐cephalic” (ICD lead via non‐cephalic route) cohorts was performed. Kaplan–Meier survival and a Cox‐regression analysis were applied to assess variables associated with lead failure. Results The cephalic and non‐cephalic cohorts were equally male (81.9% vs. 78%; p = .26), similar in age (69.7 ± 11.5 vs. 68.7 ± 11.9; p = .33) and body mass index (BMI) (27.7 ± 5.1 vs. 27.1 ± 5.7; p = .33). Most ICD leads were implanted via the cephalic vein (73.5%) and patients had a mean of 2.9 ± 0.28 leads implanted via this route. The rate of ICD lead failure was low and statistically similar between both groups (0.36%/year vs. 0.13%/year; p = .12). Female gender was more common in the lead failure cohort than non‐failure (55.6% vs. 17.9%, respectively; p = .004) as was hypertension (88.9% vs. 54.2%, respectively, p = .038). On multivariate Cox‐regression, female sex (p = .008; HR, 7.12 [1.7−30.2]), and BMI (p = .047; HR, 1.12 [1.001−1.24]) were significantly associated with ICD lead failure. Conclusion CRT‐D implantation via the cephalic route is not significantly associated with premature ICD lead failure. Female gender and BMI are predictors of lead failure.

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Section: Discussionmentioning

confidence: 99%

Multi‐lead cephalic venous access and long‐term performance of high‐voltage leads

Akhtar

Harding

Elbatran

et al. 2021

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…We believe that many small technical (11) and methodological differences could play a role in lead durability: for example, our policy is to place all leads via peel-away sheaths to protect the tip from stress produced by passage through a tortuous cephalic vein. In our series, 75% of the operators would be considered as 'cephalic-operators' with a similar well-honed technique and experience in accessing this vein, maintaining consistency and minimising error.…”

Section: Discussionmentioning

confidence: 99%

Cephalic access for multi-lead defibrillator therapy is not associated with premature high voltage lead failure

Akhtar

Harding

Batran

et al. 2020

Preprint

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Background: Cardiac resynchronisation therapy-defibrillator (CRT-D) implantation via the cephalic vein is feasible and safe. Recent evidence has suggested a higher implantable cardioverter defibrillator (ICD) lead failure in multi-lead defibrillator therapy via the cephalic route. We evaluated the relationship between CRT-D implantation via the cephalic and ICD lead failure. Methods: Data was collected from three CRT-D implanting centres between October 2008 -September 2017. In total 631 patients were included. Patient and lead characteristics with ICD lead failure were recorded. Comparison of 'cephalic' (ICD lead via cephalic) vs 'non-cephalic' (ICD lead via non-cephalic route) cohorts was performed. Kaplan-Meier survival and a Coxregression analysis were applied to assess variables associated with lead failure. Results: The cephalic and non-cephalic cohorts were equally male (82.2% vs 78.3%, p=0.28), similar in age (69.7±11.5 vs 68.7 ± 11.9, p=0.33) and body mass index (BMI) (27.7±5.1 vs 27.1±5.7, p=0.33). Most ICD leads were implanted via the cephalic vein (73.7%) and patients had a median of 2.8 leads implanted via this route. The rate of ICD lead failure was low and similar between both groups (0.4%/year vs 0.14%/year, p=0.34). Female gender was more common in the lead failure cohort than non-failure (50% vs 18.2%, respectively, p=0.01) as was hypertension (90% vs 54%, respectively, p=0.03). On multivariate Cox regression, female sex (p=0.007), hypertension (p=0.041) and BMI (p=0.042) were significantly associated with ICD lead failure. Conclusion: CRT-D implantation via the cephalic route is not associated with premature ICD lead failure. Female gender, BMI and hypertension correlate with lead failure.

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Do not yet abandon cephalic vein access for multiple leads in ICD implantation

Cited by 2 publications

References 6 publications

Multi‐lead cephalic venous access and long‐term performance of high‐voltage leads

Multi‐lead cephalic venous access and long‐term performance of high‐voltage leads

Cephalic access for multi-lead defibrillator therapy is not associated with premature high voltage lead failure

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