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

Abstract

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.

Anatomical variations in coronary venous drainage: Challenges and solutions in delivering cardiac resynchronization therapy

“…This suggests that having the experience and knowledge of the tools and techniques is more significant than the profession of the operator. 11,15 A PLSVC anomaly has been observed in 0.3% of the general population 16 and is the most common anatomical variation noted in our series. It is the remnant of the embryonic left anterior cardinal vein which connects caudally to the left duct of Cauvier and subsequently the left horn of the sinus venosus (which matures into the CS).…”

“…Although coronary interventionists are most familiar with this technique and tools, within our series the coronary venous intervention was performed by electrophysiologists. This suggests that having the experience and knowledge of the tools and techniques is more significant than the profession of the operator 11,15 …”

Axillary vein puncture versus cephalic vein cutdown for cardiac implantable electronic device implantation: A meta‐analysis

“…The study population 6,7,9–13 included 3067 transvenous leads from 1771 patients (65.6% [ n = 1162] males, average age 73.4 ± 14.3 years) (Table S1). The average follow‐up time was of 27.4 ± 19.1 months.…”

“…The study population 6,7,[9][10][11][12][13] Venography was used in four studies 7,9,11,12 and ultrasonography for AVP in two others. 10,13 Single AVP technique retaining the guidewire was employed systematically in two studies.…”

Different venous approaches for implantation of cardiac electronic devices. A network meta‐analysis

“…The initial search yielded 2904 articles, of which 36 21–56 (39,351 patients) were included in the final analysis. The flow of study selection is depicted in Figure 1.…”