Percutaneous axillary vein approach in pediatric pacing: Comparison with subclavian vein approach

Research output: Contribution to journalArticle

Abstract

Aims The subclavian vein approach has been used for 20 years in our center for pacemaker (PM) implantation in children, but it carries risks of hemothorax/pneumothorax and lead fracture, which could be reduced by axillary vein approach. Methods and Results This is a prospective study enrolling the first 48 consecutive pediatric patients (age: 12.3 ± 4.6 years) who underwent PM/implantable cardioverter-defibrillator leads implantation through axillary vein (guided by contrast venography) between 2009 and 2012 (group I). A comparison was made with the outcomes of the subclavian vein approach (group II) in 41 patients, age 12.3 ± 4.8 years, consecutively enrolled between 2006 and 2011. The two groups showed no significant differences for the variables examined except for follow-up, longer in group II, and for alternative ventricular pacing sites, more frequent in group I. Axillary vein diameter was 7.9 ± 1.7 mm and showed positive correlation with height (r = 0.77). The axillary vein approach was effective in 93.7% of patients. The unsuccessful procedures occurred in patients with significantly lower age and smaller venous diameters. The subclavian vein approach was effective in 100% of patients. Sixty-two leads were implanted in group I, 54 in group II. There were neither intraoperative complications in both the groups, nor significant differences for early and late complications. Conclusions The axillary vein approach for PM implantation in children is effective and safe for physicians skilled with subclavian vein approach. Younger patients with smaller vein diameters are at low risk for unsuccessful procedure.

Original languageEnglish
Pages (from-to)1550-1557
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume36
Issue number12
DOIs
Publication statusPublished - Dec 2013

Fingerprint

Axillary Vein
Subclavian Vein
Pediatrics
Hemothorax
Implantable Defibrillators
Phlebography
Intraoperative Complications
Pneumothorax
Veins
Prospective Studies
Physicians

Keywords

  • cardiac pacing
  • children
  • congenital heart defect
  • pacing complication
  • transvenous pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{14846fc8e86f41c682bbf806d4b12468,
title = "Percutaneous axillary vein approach in pediatric pacing: Comparison with subclavian vein approach",
abstract = "Aims The subclavian vein approach has been used for 20 years in our center for pacemaker (PM) implantation in children, but it carries risks of hemothorax/pneumothorax and lead fracture, which could be reduced by axillary vein approach. Methods and Results This is a prospective study enrolling the first 48 consecutive pediatric patients (age: 12.3 ± 4.6 years) who underwent PM/implantable cardioverter-defibrillator leads implantation through axillary vein (guided by contrast venography) between 2009 and 2012 (group I). A comparison was made with the outcomes of the subclavian vein approach (group II) in 41 patients, age 12.3 ± 4.8 years, consecutively enrolled between 2006 and 2011. The two groups showed no significant differences for the variables examined except for follow-up, longer in group II, and for alternative ventricular pacing sites, more frequent in group I. Axillary vein diameter was 7.9 ± 1.7 mm and showed positive correlation with height (r = 0.77). The axillary vein approach was effective in 93.7{\%} of patients. The unsuccessful procedures occurred in patients with significantly lower age and smaller venous diameters. The subclavian vein approach was effective in 100{\%} of patients. Sixty-two leads were implanted in group I, 54 in group II. There were neither intraoperative complications in both the groups, nor significant differences for early and late complications. Conclusions The axillary vein approach for PM implantation in children is effective and safe for physicians skilled with subclavian vein approach. Younger patients with smaller vein diameters are at low risk for unsuccessful procedure.",
keywords = "cardiac pacing, children, congenital heart defect, pacing complication, transvenous pacing",
author = "Silvetti, {Massimo Stefano} and Silvia Placidi and Rosalinda Palmieri and Daniela Righi and Lucilla Rav{\`a} and Fabrizio Drago",
year = "2013",
month = "12",
doi = "10.1111/pace.12283",
language = "English",
volume = "36",
pages = "1550--1557",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Percutaneous axillary vein approach in pediatric pacing

T2 - Comparison with subclavian vein approach

AU - Silvetti, Massimo Stefano

AU - Placidi, Silvia

AU - Palmieri, Rosalinda

AU - Righi, Daniela

AU - Ravà, Lucilla

AU - Drago, Fabrizio

PY - 2013/12

Y1 - 2013/12

N2 - Aims The subclavian vein approach has been used for 20 years in our center for pacemaker (PM) implantation in children, but it carries risks of hemothorax/pneumothorax and lead fracture, which could be reduced by axillary vein approach. Methods and Results This is a prospective study enrolling the first 48 consecutive pediatric patients (age: 12.3 ± 4.6 years) who underwent PM/implantable cardioverter-defibrillator leads implantation through axillary vein (guided by contrast venography) between 2009 and 2012 (group I). A comparison was made with the outcomes of the subclavian vein approach (group II) in 41 patients, age 12.3 ± 4.8 years, consecutively enrolled between 2006 and 2011. The two groups showed no significant differences for the variables examined except for follow-up, longer in group II, and for alternative ventricular pacing sites, more frequent in group I. Axillary vein diameter was 7.9 ± 1.7 mm and showed positive correlation with height (r = 0.77). The axillary vein approach was effective in 93.7% of patients. The unsuccessful procedures occurred in patients with significantly lower age and smaller venous diameters. The subclavian vein approach was effective in 100% of patients. Sixty-two leads were implanted in group I, 54 in group II. There were neither intraoperative complications in both the groups, nor significant differences for early and late complications. Conclusions The axillary vein approach for PM implantation in children is effective and safe for physicians skilled with subclavian vein approach. Younger patients with smaller vein diameters are at low risk for unsuccessful procedure.

AB - Aims The subclavian vein approach has been used for 20 years in our center for pacemaker (PM) implantation in children, but it carries risks of hemothorax/pneumothorax and lead fracture, which could be reduced by axillary vein approach. Methods and Results This is a prospective study enrolling the first 48 consecutive pediatric patients (age: 12.3 ± 4.6 years) who underwent PM/implantable cardioverter-defibrillator leads implantation through axillary vein (guided by contrast venography) between 2009 and 2012 (group I). A comparison was made with the outcomes of the subclavian vein approach (group II) in 41 patients, age 12.3 ± 4.8 years, consecutively enrolled between 2006 and 2011. The two groups showed no significant differences for the variables examined except for follow-up, longer in group II, and for alternative ventricular pacing sites, more frequent in group I. Axillary vein diameter was 7.9 ± 1.7 mm and showed positive correlation with height (r = 0.77). The axillary vein approach was effective in 93.7% of patients. The unsuccessful procedures occurred in patients with significantly lower age and smaller venous diameters. The subclavian vein approach was effective in 100% of patients. Sixty-two leads were implanted in group I, 54 in group II. There were neither intraoperative complications in both the groups, nor significant differences for early and late complications. Conclusions The axillary vein approach for PM implantation in children is effective and safe for physicians skilled with subclavian vein approach. Younger patients with smaller vein diameters are at low risk for unsuccessful procedure.

KW - cardiac pacing

KW - children

KW - congenital heart defect

KW - pacing complication

KW - transvenous pacing

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U2 - 10.1111/pace.12283

DO - 10.1111/pace.12283

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