- 作者：Gautam Sharma ; Nagendra Boopathy Senguttuvan ; Ajit Thachil ; Darryl Leong ; Nitish Naik ; Rakesh Yadav ; Rajnish Juneja ; Vinay K. Bahl
- 刊名：Canadian Journal of Cardiology
- 出版年：2012
- 出版时间：September-October, 2012
- 年：2012
- 卷：28
- 期：5
- 页码：542-546
- 全文大小：753 K
Background
The intrathoracic subclavian venous technique for pacemaker implantation may be associated with serious complications. We describe an alternative technique for obtaining venous access for pacemaker implantation through axillary vein under fluoroscopic guidance and compare it with the conventional, subclavian approach.Methods
We conducted a single-centre, prospective, nonrandomized study. All adult patients with indication for permanent pacing who consented were recruited during a 3-year period. To access the axillary vein, we used the alternative technique with a new fluoroscopic landmark. The subclavian access was obtained as per the usual approach.
Results
We studied 478 lead placements during 3 years; 315 lead placements through axillary venous technique (group 1) were compared with 163 lead placements through subclavian venous technique (group 2). Both routes had a high and comparable success rate, 98.09 % in group 1 and 96.93 % in group 2. The axillary approach was successful at the first attempt in 194 punctures (61.6 % ), as vs 60 in group 2 (36.8 % ) P < 0.0001. The average number of attempts in group 1 was 2.06 per patient and 2.56 in group 2 (P < 0.001). There were 3 (2.94 % ) pneumothoraxes in group 2 and none in group 1. During a mean follow-up period of 3.2 months in group1 and 3.7 months in group 2, 1 patient in group 2 had a lead fracture.
Conclusions
The fluoroscopically guided axillary venous approach for implanting permanent pacemakers is equivalent to the traditional anatomic landmark-guided intrathoracic subclavian approach and has fewer complications and shorter procedural time to access the vein.