Safety of triple chamber cardiac electronic devices implantation using a double venous approach

Introduction: Given the higher number of leads, the most appropriate venous approach technique for implantation of triple chamber cardiac resynchronization therapy (CRT) devices, is not yet established. Th e aim of our study is to analyze the safety and possible superiority of a double venous approach, cephalic and subclavian, compared to single vein approach, using the classic subclavian vein and the alternative cephalic vein alone, regarding fl uoroscopy time, and procedure related difficulties and complications. Methods: We retrospectively analyzed 118 patients implanted with a triple chamber device, pacemaker or defi brillator, at Timișoara Institute of Cardiovascular Diseases between 1st of January 2000 and 1st of June 2014. The patients were divided in three groups according to the implantation technique: double venous approach (group A – 70 patients, with the coronary sinus (CS) lead through the subclavian vein, the right ventricle lead through the cephalic vein, and the right atrium lead in 51 patients through the cephalic vein and in 19 through the subclavian vein), subclavian vein approach alone (group B – 22 patients), and cephalic vein approach alone (group C – 26 patients). All groups were compared by the rate of complications requiring intervention, difficulty in placing the CS lead and the intervention fluoroscopy time. Results: We encountered 3 complications in group A (4.2%), 4 in group B (18.1%), and 6 in group C (23%). Adjusting for age and sex, our data show that group A – double venous approach with both its subgroups, had a signifi cantly lower complication rate compared to single vein approach, either subclavian (group B) or cephalic (group C) (Fischer’s exact p = 0.03). As for the diffi culty in placing the coronary sinus lead and the fluoroscopy time required, there is no evidence in the data that there are statistically signifi cant diff erences between the three groups (Fisher’s exact p = 0.141 and ANOVA p = 0.42, respectively). Conclusions: Double venous approach, using both subclavian and cephalic veins, for triple chamber CRT devices implantation, seems to be safer than single venous approach regarding the complication rate, and non-inferior, regarding difficulty of placing the coronary sinus lead and interventional fluoroscopy time. We strongly recommend it for routine use. Acknowledgement. Th is study was conducted under the frame of European Social Found, Human Resources Development Operational Programme 2007- 2013, Project no. POSDRU/159/1.5/S/136893.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)