Perioperative complications after pacemaker implantation: higher complication rates with subclavian vein puncture than with cephalic vein cutdown

Abstract

Purpose The cephalic vein cutdown (CVC) and the subclavian puncture (SP) is the most common access for pacemaker implantation. The purpose of this study was to compare the peri-/postoperative complications of these approaches. Methods A retrospective analysis of the quality assurance data of the state of North Rhine-Westphalia was performed to evaluate the peri-/postoperative complications of first pacemaker implantation according to the venous access. The primary endpoint was defined as the occurrence of one of the following: asystole, ventricular fibrillation, pneumothorax, hemothorax, pericardial effusion, pocket hematoma, lead dislocation, lead dysfunction, postoperative wound infection or other complication requiring intervention. Descriptive analysis was done via absolute, relative frequencies and Odds Ratio. Fisher’s exact test was used for comparison of the both study groups. Results From 139,176 pacemaker implantations from 2010 to 2014, 15,483 cases were excluded due to other/double access. The median age was 78 years and the access used was CVC for 75,251 cases (60.8%) and SP for 48,442 cases (39.2%). The implanted devices were mainly dual-chamber pacemakers (73.9% in the CVC group and 78.4% in the SP group), followed by single-chamber pacemakers VVI (24.9% and 19.9% in the CVC and SP group respectively). There were significantly fewer peri/postoperative complications in the CVC group compared to the SP group (2.49% vs. 3.64%, p = 0.0001, OR 1.47; 95% CI 1.38–1.57). Conclusions CVC as venous access for pacemaker implantation has significantly fewer peri/postoperative complications than SP and appears to be an advantageous technique.

Caudal fluoroscopic guidance for the insertion of transvenous pacing leads

“…Technique modifications led to the uptake of imaging guidance, including fluoroscopy, ultrasound, and contrast venography. However, despite these advancements, reported rates of pneumothorax with axillary/subclavian puncture remain between 0% and 2.3% 1,8–19 …”

“…However, despite these advancements, reported rates of pneumothorax with axillary/subclavian puncture remain between 0% and 2.3%. 1,[8][9][10][11][12][13][14][15][16][17][18][19] Our data provide evidence that the caudal fluoroscopic technique may further improve the safety of axillary/subclavian puncture and prevent pneumothorax. While complication rates overall were low, axillary/subclavian puncture completed with caudal imaging had a 72% lower risk of pneumothorax compared to conventional AP imaging.…”

Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study

“…In our study, 0.8% of patients developed a pocket hematoma, which is higher than studies conducted in Germany (0.2%) and Spain (0.32%), but lower than studies conducted in Cameroon (1.5%), Iraq (1%), and the Netherlands (2.9%). 9 , 11 , 12 , 16 , 21 This discrepancy in pocket hematoma rate can be explained by differences in age distribution and comorbidities like coagulopathy.…”

A massive hemothorax resulted from injury to the left subclavian artery branch during pacemaker implantation: case report and literature review

“…and give early treatment.Third,an interdisciplinary team should be established according to the ESC guidelines for cardiac pacing and cardiac resynchronization in 2021 [1] ,when hemothorax occurs,the surgeon should be contacted for VATS for diagnosis and treatment of injured vessels. Fourthly, Puncture subclavian venous catheterization is one of the most common iatrogenic hemothorax causes [7] .Axillary venipuncture or cephalic venotomy could reduce postoperative complications [8,9] Fig1 : The pacemaker and Chest computed tomography Fig2 :The video-assisted thoracic surgery…”