Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation

Kotter, John; Lolay, Georges; Charnigo, Richard; Leung, Steve W.; McKibbin, Christopher R.; Sousa, Matthew; Jiménez, L.; Gurley, John C.; Biase, Luigi Di; Smyth, Susan S.; Darrat, Yousef; Morales, Gustavo; Elayi, Claude S.

doi:10.1111/pace.12901

Cited by 18 publications

(16 citation statements)

References 20 publications

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“…US, with the added visualization of the needle piercing the venous wall, may further decrease that risk compared to fluoroscopic guidance alone as it may potentially allow for more peripheral axillary vein cannulation. Kotter et al compared the rate of pneumothorax in 1264 CIED procedures and they reported no pneumothoraces with axillary venous access cases (385 patients) compared to 21 patients (2.4%) who underwent subclavian access . Additionally, they reported two episodes of lead crush injury, which were both in the subclavian access group.…”

Section: Discussionmentioning

confidence: 99%

“…Kotter et al compared the rate of pneumothorax in 1264 CIED procedures and they reported no pneumothoraces with axillary venous access cases (385 patients) compared to 21 patients (2.4%) who underwent subclavian access. 9 Additionally, they reported two episodes of lead crush injury, which were both in the subclavian access group. Lin et al utilized US for access in adults undergoing CIED placement and reported no pneumothoraces compared to three (0.4%) patients in the traditional access group.…”

Section: Discussionmentioning

confidence: 99%

“…Subclavian access carries significant acute procedural risks including the potential for hemothorax, pneumothorax, nerve injury, and higher potential risk of lead fracture . The rate of pneumothorax for new cardiac implantable electronic device (CIED) implant procedures in adults ranges from 0.6%‐2.8%, with an increased risk in patients undergoing subclavian venous access compared to an axillary venous approach . Data on pediatric CIED outcomes are limited in comparison to the adult literature.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] The rate of pneumothorax for new cardiac implantable electronic device (CIED) implant procedures in adults ranges from 0.6%-2.8%, [6][7][8] with an increased risk in patients undergoing subclavian venous access compared to an axillary venous approach. 9 Data on pediatric CIED outcomes are limited in comparison to the adult literature. Published incidence of pneumothorax or hemothorax complicating pediatric CIED implants ranges from 0.3% in a large review of implantable cardioverter-defibrillator (ICD) implantations in the National Cardiovascular Disease Registry (NCDR) 10 to 7% in a multicenter registry.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound‐guided axillary venous access for pediatric and adult congenital lead implantation

Clark

Janson

Nappo

et al. 2018

Pacing Clinical Electrophis

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Background Axillary venous access with ultrasound guidance for pediatric transvenous lead implantation may reduce risks for pneumothorax and hemothorax. The objective was to retrospectively evaluate ultrasound‐guided axillary vein access as an alternative to the subclavian approach. Methods The technique consists of ultrasonographic identification of the axillary vein at the deltopectoral groove after initial contrast venography. A micropuncture kit is used for initial ultrasound‐guided percutaneous access with fluoroscopic confirmation of wire position. Pocket creation is performed, and sheath insertion and lead implantation proceed as usual. Demographic, procedural, and radiation exposure data were collected and analyzed. Results Sixteen patients (median age = 13 years, 8‐50 years; median weight = 56 kg, 29‐77 kg) underwent lead implantation; two additional patients required fluoroscopy due to poor acoustic windows (89% success). Fifteen of 21 leads (71%) were ventricular; 50% of implants were pacemakers, and 31% were dual chamber. Median time to venous access was 13 min (interquartile range (IQR) = 9.25‐20.25) and median implant procedure time was 156 min (IQR = 112‐172). Median fluoroscopy time was 18.0 min (IQR = 11.9‐29.6), median air kerma was 9.0 mGy (IQR = 3.0‐28.5), and median dose‐area product was 30.2 Gy‐cm2 (IQR = 16.1‐234.5). One patient required generator pocket revision 2 days postprocedure without lead dislodgement. There were no other complications encountered. Conclusions Transvenous pacemaker and implantable cardioverter‐defibrillator lead implantation in the pediatric and adult congenital population through ultrasound‐guided axillary venous access is safe and efficacious. This technique may provide a low‐risk alternative for vascular access for pediatric implantation procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasound‐guided axillary venous access for pediatric and adult congenital lead implantation

Clark

Janson

Nappo

et al. 2018

Pacing Clinical Electrophis

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“…Learning curve is short and it does not require fluoroscopy or venography for AV imaging. It showed reduction in number of attempts, time for venous access, and complications . Reduction in number of attempts may also prevent the occurrence of procedural pain.…”

Section: Discussionmentioning

confidence: 95%

Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices

Bozyel

Yalnız

Aksu

et al. 2019

Pacing Clinical Electrophis

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Background:Combined ultrasound (US)-guided pectoral nerves (PECS) block and axillary vein (AV) puncture for cardiac implantable electronic devices can be effective to achieve optimal perioperative pain management and prevent access-related complications. Methods:A total of 36 patients who underwent combined US-guided PECS block and AV puncture were included. All routinely recorded parameters, including clinical and demographic characteristics, periprocedural medical administrations, the time taken for both PECS block and AV puncture, procedure time, postprocedural pain score, and procedure-related complications, were collected and analyzed. Results: In total, 54 leads were placed in 36 patients. The combined US-guided PECS block and AV puncture was performed successfully in 35 (97.2%) patients without the need for fluoroscopy or venography. AV access for each lead was achieved in a single attempt in 80.6% of cases. The time for both PECS block and AV puncture was 223.6 ± 52.1 s, including the time to apply incision site anesthesia. Additional sedatives and/or local anesthetics were required in two patients during procedure. Visual analog scale average of the patients in the 1st, 6th, and 24th h was 3.7 ± 1.14. 1.61 ± 1.29, and 0.08 ± 0.28, respectively. After the procedure, four patients (three of them woman) needed analgesics. There were no venous access-related complications. Conclusions: This new combined technique maintains both surgical and postoperative analgesia and prevents vascular access-related complications without significant increase on procedure time. K E Y W O R D S axillary vein, cardiac implantable electronic devices, pectoral nerve block, ultrasound, venous access 1 1026

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Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study

Domokos

Szabó

Banhegyi³

et al. 2019

J Interv Card Electrophysiol

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Purpose Pneumothorax (PTX) following cardiac implantable electronic device procedures is traditionally treated with chest tube drainage (CTD). We hypothesized that, in a subset of patients, the less invasive needle aspiration (NA) may also be effective. We compared the strategy of primary NA with that of primary CTD in a single-center observational study. Methods Of the 970 procedures with subclavian venous access between January 2016 and June 2018, 23 patients had PTX requiring intervention. Beginning with March 2017, the traditional primary CTD (9 cases) has been replaced by the "NA first" strategy (14 patients). Outcome measures were procedural success rate and duration of hospitalization evaluated both as time to event (log-rank test) and as a discrete variable (Wilcoxon-Mann-Whitney test). Results Needle aspiration was successful in 8/14 (57.1%) of the cases (95% CI 28.9-82.3%), whereas PTX resolved in all patients after CTD was 9/9 (100%, 95% CI 66.4-100.0%, p = 0.0481). Regarding length of hospital stay, intention to treat time to event analysis showed no difference between the two approaches (p = 0.73). Also, the median difference was not statistically significant (− 2.0 days, p = 0.17). In contrast, per protocol evaluation revealed reduced risk of prolonged hospitalization for NA patients (p = 0.0025) with a median difference of − 4.0 days (p = 0.0012). Failure of NA did not result in a meaningful delay in discharge timing as median difference was 1.5 days (p = 0.28). Conclusions Our data suggest that in a number of patients iatrogenic PTX may be successfully treated with NA resulting in shorter hospitalization without the risk of meaningful discharge delay in unsuccessful cases.

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Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation

Cited by 18 publications

References 20 publications

Ultrasound‐guided axillary venous access for pediatric and adult congenital lead implantation

Ultrasound‐guided axillary venous access for pediatric and adult congenital lead implantation

Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices

Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study

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