Long‐term incidence of upper extremity venous obstruction in implantable cardioverter defibrillator patients

Abstract

Background Very little is known about the long‐term prevalence of severe venous obstruction and occlusion in patients with transvenous implantable cardioverter‐defibrillator leads. The objective of the current investigation was to elucidate the incidence and prevalence and to identify predisposing conditions in an ICD cohort over a long follow‐up period. Methods Based on a prospective database, we analyzed consecutive patients who received an ICD implantation in our hospital between 06/1988 and 2009 as well as all corresponding follow‐up data until 02/2018. Cavographies were used for analysis, and all patients with at least one device replacement and one follow‐up cavography were included. Results Over a mean follow‐up period of 94 ± 50 months, severe venous obstruction was found in 147 (33%) of 448 patients. Kaplan‐Meier analysis shows a severe obstruction or occlusion in 50% of patients after a period of 14.3 years. The total number of leads (p < .001, HR 2.01, CI 2.000–2.022), an advanced age (p = .004, HR 1.023 per year, CI 1.022–1.024) and the presence of dilated cardiomyopathy (p = .035, HR 1.49, CI 1.47–1.51) were predictive of venous obstruction whereas the presence of anticoagulation was not. Conclusion Severe obstruction of the access veins after ICD implantation occurs frequently and its prevalence shows a nearly linear increase over long‐time follow‐up. Multiple leads, an advanced age and DCM as underlying disease are associated with an increased risk of venous obstruction while the role of anticoagulation to prevent venous obstruction in ICD patients is unclear.

Transvenous versus subcutaneous implantable cardioverter defibrillators in young cardiac arrest survivors

“…29 ‡Risk of lead thrombosis/venous occlusion increases linearly with lead age and may occur in up to 50% of patients after 14.3 years. 30 §Abnormal tricuspid regurgitation defined as grade 1.5-3+. ¶Annual risk of lead failure increases with age and is seen in 20% of 10-year-old defibrillator leads.…”

“… ‡ Risk of lead thrombosis/venous occlusion increases linearly with lead age and may occur in up to 50% of patients after 14.3 years 30 …”

Initial Experience with Intercostal Insertion of an Extravascular ICD Lead Compatible with Existing Pulse Generators

“…1,2 The mortality benefit conferred with transvenous ICDs (TV-ICDs) is not without risk of acute lead complications, including hemothorax, pneumothorax, cardiac perforation, and tamponade [3][4][5][6][7] and delayed complications, which consist primarily of lead failures, venous thrombosis, and bloodstream infection. [8][9][10][11][12][13] In certain sub-populations, such as end-stage renal disease patients requiring dialysis, the risks of bloodstream infection and/or central venous stenosis outweigh potential benefit of transvenous ICD implantation despite high risk of SCD. 14 Additionally, transvenous ICD lead placement may be precluded in patients with occluded or limited venous access, prior thoracic radiotherapy, or anomalous cardiac anatomy.…”

Initial Experience With Intercostal Insertion of an Extravascular ICD Lead Compatible With Existing Pulse Generators

“…1,2 The mortality benefit conferred with transvenous ICDs (TV-ICDs) is not without risk of acute lead complications, including hemothorax, pneumothorax, cardiac perforation, and tamponade [3][4][5][6][7] and delayed complications, which consist primarily of lead failures, venous thrombosis, and bloodstream infection. [8][9][10][11][12][13] In certain subpopulations, such as end-stage renal disease patients requiring dialysis, the risks of bloodstream infection and central venous stenosis outweigh potential benefit of TV-ICD implantation despite high risk of sudden cardiac death. 14 Additionally, TV-ICD lead placement may be precluded in patients with occluded or limited venous access, prior thoracic radiotherapy, or anomalous cardiac anatomy.…”