Surgical options for endocardial lead placement when upper veins are obstructed or nonusable

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
J Ernesto Molina

Abstract

In 35 patients (24 adults, 11 children), two techniques were used to implant endocardial pacemaker or defibrillator leads in the presence of complete occlusion or nonusability of upper veins. The obstructed veins were the subclavian, innominate, and superior vena cava (SVC). Most of the obstructions occurred secondary to previous implant of multiple leads. Twenty-four patients had occlusion of the subclavian veins; 7 of both the subclavians and innominates; 4 had stenosis of the SVC. Twenty-seven patients with obstructed subclavian veins, but with patent innominates, underwent direct implants via cut-down internal jugular vein for one or two leads, as needed. Eight patients with obstructed innominate veins or SVC underwent a direct transthoracic transatrial approach (TTTA). This method involves a parasternal extrapleural route through the mediastinum to directly puncture the right atrium. The leads are then implanted endocardially, under fluoroscopy. There were no complications with either method, and the implanted units have been working well during up to 14 years follow-up. These two techniques circumvent the problem of obstructed upper veins--which limits the options for implanting endocardial pacing systems.

Citations

Jun 25, 2005·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Klaus K A WitteKumaraswamy Nanthakumar
Nov 26, 2009·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Mohammad Al-BatainehSteven Kutalek
Apr 2, 2011·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Lars LüthjeDirk Vollmann
Aug 19, 2011·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Senthil KirubakaranChristopher A Rinaldi
Jan 18, 2011·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Claude S ElayiJohn C Gurley
Apr 7, 2010·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Roger G CarrilloArif Asif
Oct 14, 2005·Pacing and Clinical Electrophysiology : PACE·Steven R MickelsenFred Kusumoto
Jun 23, 2007·Pacing and Clinical Electrophysiology : PACE·Ernest W Lau
Oct 15, 2009·Pacing and Clinical Electrophysiology : PACE·Ravi Ranjan, Charles A Henrikson
Apr 4, 2016·The Annals of Thoracic Surgery·Stany SandrioAndré Rüffer
Mar 20, 2018·The Journal of Vascular Access·Mariusz Kusztal, Krzysztof Nowak
Jul 1, 2018·Indian Journal of Thoracic and Cardiovascular Surgery : Official Organ, Association of Thoracic and Cardiovascular Surgeons of India·Nicholas Stanley ClarkeMichael Erik Jessen
Jan 26, 2021·Indian Pacing and Electrophysiology Journal·Viveka KumarVivek Kumar
Jul 22, 2021·Pacing and Clinical Electrophysiology : PACE·Johanna B TonkoChristopher A Rinaldi
Aug 29, 2021·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Johanna B Tonko, Christopher A Rinaldi

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