This article is more than 5 years old. Information may no longer be current.
Cephalic vein cutdown safest for lead insertion of implantable cardiac devices
In a meta-analysis of venous access techniques for implantation of cardiac implantable electronic devices, cephalic vein cutdown conferred lower risk for pneumothorax and lead failure compared with subclavian vein puncture, researchers reported at the American College of Cardiology Scientific Session.
There was no difference in outcomes between cephalic vein cutdown and axillary vein puncture, according to the meta-analysis, which was simultaneously published in JACC: Clinical Electrophysiology.
“Cephalic vein cutdown, subclavian vein puncture and axillary vein puncture are all widely used techniques for lead insertion in clinical practice. However, the use of one technique over the other is largely limited by operator experience and local practice patterns,” Mohit K. Turagam, MD, cardiac electrophysiology fellow at The Mount Sinai Hospital, told Healio. “Based on the current clinical evidence, it remains unclear which technique is safer and preferred during cardiac implantable electronic device (CIED) implantation. In this context, we performed a pooled analysis of all the studies available in the literature to evaluate the efficacy and safety of subclavian vein puncture and axillary vein puncture compared with cephalic vein cutdown for CIED implantation.”
The meta-analysis included 23 studies of 35,722 patients who had a CIED implanted, including 18,009 who had subclavian vein puncture, 409 who had axillary vein puncture and 17,304 who had cephalic vein cutdown. The range of follow-up was 1 month to 8 years.
According to the researchers, patients whose procedure included subclavian vein puncture were at greater risk for pneumothorax (RR = 4.88; 95% CI, 2.95-8.06) and lead or device failure (RR = 2.09; 95% CI, 1.07-4.09) compared with those who had a procedure with cephalic vein cutdown.
There was no difference between the cephalic vein cutdown and axillary vein puncture groups in pneumothorax and lead or device failure, and there was no difference between any of the groups in other complications, including pocket hematoma/bleeding, device infection and pericardial effusion, the researchers found.
However, acute procedural success was lower in the cephalic vein cutdown group compared with the subclavian vein puncture group (RR = 1.24; 95% CI, 1-1.53).
“Our pooled analysis including over 35,000 patients suggests that cephalic vein cutdown as the safest venous access available for lead insertion, as it avoids potential complications such as pneumothorax and subclavian crush syndrome and lead failure related to subclavian vein puncture,” Turagam told Healio. “However, the operators should be aware about the poor acute procedural success and higher blood loss that can observed with cephalic vein cutdown. Furthermore, axillary vein puncture also remains a suitable alternative with similar safety and efficacy as cephalic vein cutdown.” – by Erik Swain
References:
Atti V, et al. Abstract 1217-246. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
Atti V, et al. JACC Clin Electrophysiol. 2020;doi:10.1016/j.jacep.2020.01.006.
Disclosure: One author reports he is a consultant for Abbott, Baylis, Biosense Webster, Biotronik, Boston Scientific and Medtronic.