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Vetta G, Magnocavallo M, Parlavecchio A, Caminiti R, Polselli M, Sorgente A, Cauti FM, Crea P, Pannone L, Marcon L, Savio AL, Pistelli L, Vetta F, Chierchia GB, Rossi P, Bianchi S, Natale A, de Asmundis C, Rocca DGD. Axillary vein puncture versus cephalic vein cutdown for cardiac implantable electronic device implantation: A meta-analysis. Pacing Clin Electrophysiol 2023; 46:942-947. [PMID: 37378419 DOI: 10.1111/pace.14728] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Cephalic vein cutdown (CVC) and axillary vein puncture (AVP) are both recommended for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile. METHODS We systematically searched Medline, Embase, and Cochrane electronic databases up to September 5, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary endpoints were acute procedural success and overall complications. The effect size was estimated using a random-effect model as risk ratio (RR) and relative 95% confidence interval (CI). RESULTS Overall, seven studies were included, which enrolled 1771 and 3067 transvenous leads (65.6% [n = 1162] males, average age 73.4 ± 14.3 years). Compared to CVC, AVP showed a significant increase in the primary endpoint (95.7 % vs. 76.1 %; RR: 1.24; 95% CI: 1.09-1.40; p = .001) (Figure 1). Total procedural time (mean difference [MD]: -8.25 min; 95% CI: -10.23 to -6.27; p < .0001; I2 = 0%) and venous access time (MD: -6.24 min; 95% CI: -7.01 to -5.47; p < .0001; I2 = 0%) were significantly shorter with AVP compared to CVC. No differences were found between AVP and CVC for incidence overall complications (RR: 0.56; 95% CI: 0.28-1.10; p = .09), pneumothorax (RR: 0.72; 95% CI: 0.13-4.0; p = .71), lead failure (RR: 0.58; 95% CI: 0.23-1.48; p = .26), pocket hematoma/bleeding (RR: 0.58; 95% CI: 0.15-2.23; p = .43), device infection (RR: 0.95; 95% CI: 0.14-6.60; p = .96) and fluoroscopy time (MD: -0.24 min; 95% CI: -0.75 to 0.28; p = .36). CONCLUSION Our meta-analysis suggests that AVP may improve procedural success and reduce total procedural time and venous access time compared to CVC.
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Affiliation(s)
- Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Magnocavallo
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Polselli
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Filippo Maria Cauti
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Lorenzo Marcon
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Armando Lo Savio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lorenzo Pistelli
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Vetta
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Stefano Bianchi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
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Giacopelli D, Azzolina D, Comoretto RI, Quartieri F, Rovaris G, Schillaci V, Gargaro A, Gregori D. Implantable cardioverter defibrillator lead performance: A systematic review and individual patient data Meta-analysis. Int J Cardiol 2023; 373:57-63. [PMID: 36460209 DOI: 10.1016/j.ijcard.2022.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reliable post-approval surveillance of implantable cardioverter-defibrillator (ICD) lead performance remains a challenge. In the past, two ICD leads were recalled due to a high frequency of failures. In this meta-analysis, we sought to provide a combined estimate of failure-free rate for ICD leads by reconstructing individual patient data from published Kaplan-Meier (KM) curves and to investigate whether estimates could be influenced by the characteristics of the study. METHODS Observational studies assessing failure-free estimates of transvenous ICD leads with KM method, were identified through a systematic search up to November 2021. RESULTS Forty-four studies were eligible that included 41,870 (63.1%) non-recalled leads and 24,493 (36.9%) recalled leads. The 8-year cumulative failure-free rate was 94.1% (CI, 93.6% - 94.6%) for contemporary non-recalled leads and 81.2% (80.3% - 82.0%) for recalled leads (hazard ratio [HR], 3.15 [2.85-3.47], p < 0.001). Failure-free rate was lower in single-center studies in both the non-recalled (HR, 0.28 [0.15-0.51], p < 0.001) and recalled (HR, 0.54 [0.33-0.88], p = 0.014) group compared with multicenter studies. Similarly, estimates were significantly lower in small (i.e. extracted KM curve with <312 leads) versus large studies (HR non-recalled group, 0.54 [CI, 0.33-0.89], p = 0.015; HR recalled group, 0.62 [CI, 0.43-0.89], p = 0.009). CONCLUSIONS In this meta-analysis including >66,000 leads, we provide pooled survival curves that may play a role in generating evidence-based standards for assessing clinically acceptable failure rates for ICD leads. Lead performance was underestimated with single-center and small-sized studies; multicenter studies remain the main tool to reliably conduct post-market surveillance of ICD leads.
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Affiliation(s)
- Daniele Giacopelli
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy; Clinical Unit, Biotronik Italia, Milan, Italy.
| | - Danila Azzolina
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | | | - Fabio Quartieri
- Department of Cardiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | | | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy
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Anagnostopoulos I, Kossyvakis C, Kousta M, Verikokkou C, Lakka E, Karakanas A, Deftereos G, Spanou P, Giotaki S, Vrachatis D, Avramidis D, Deftereos S, Giannopoulos G. Different venous approaches for implantation of cardiac electronic devices. A network meta-analysis. Pacing Clin Electrophysiol 2022; 45:717-725. [PMID: 35554947 DOI: 10.1111/pace.14510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Many of the complications arising from cardiac device implantation are associated to the venous access used for lead placement. Previous analyses reported that cephalic vein cutdown (CVC) is safer but less effective than subclavian vein puncture (SVP). However, comparisons between these techniques and axillary vein puncture (AVP) -guided either by ultrasound or fluoroscopy- are lacking. Thus, we aimed to compare safety and efficacy of these approaches. METHODS We searched for articles assessing at least two different approaches regarding the incidence of pneumothorax and/ or lead failure (LF). When available, bleeding and infectious complications as well as procedural success were analyzed. A frequentist random effects network meta-analysis model was adopted. RESULTS 36 studies were analyzed. Most articles assessed SVP versus CVC. Compared to SVP, both CVC and AVP were associated with reduced odds of pneumothorax (OR: 0.193, 95%CI: 0.136-0.275 and OR: 0.128, 95%CI: 0.050- 0.329; respectively) and LF (OR: 0.63, 95%CI: 0.406-0.976 and OR: 0.425, 95%CI: 0.286-0.632; respectively). No significant differences between AVP and CVC were demonstrated. Limited data suggest no major impact of different approaches on infectious and bleeding complications. Initial CVC approach required significantly more often an alternate/ additional venous access for lead placement, compared to both AVP and SVP. No differences between these two were identified. CONCLUSION Both AVP and CVC seem to decrease incident pneumothorax and LF, compared to SVP. Initial AVP approach seems to decrease the need of alternate venous access, compared to CVC. These results suggest that AVP should be further clinically tested. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | | | - Eleni Lakka
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Asterios Karakanas
- 2nd Department of Cardiology, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Gerasimos Deftereos
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Polixeni Spanou
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Sotiria Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Avramidis
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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Akhtar Z, Sohal M, Kontogiannis C, Harding I, Zuberi Z, Bajpai A, Norman M, Pearse S, Beeton I, Gallagher MM. Anatomical variations in Coronary Venous Drainage: Challenges and Solutions in Delivering Cardiac Resynchronisation Therapy. J Cardiovasc Electrophysiol 2022; 33:1262-1271. [PMID: 35524414 DOI: 10.1111/jce.15524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the abnormalities of the coronary venous system in candidates for cardiac resynchronization therapy (CRT) and describe methods for circumventing the resulting difficulties. METHODS From 4 implanting institutes, data of all CRT implants between October 2008-October 2020 were screened for abnormal cardiac venous anatomy, defined as an anatomical variation not conforming to the accepted 'normal' anatomy. Patient demographics, procedural detail and subsequent left ventricle (LV) lead pacing indices were collected. RESULTS From a total of 3548 CRT implants, 15 (0.42%) patients (80% male) of 72.2±10.6 years in age with a LV ejection fraction of 34±10.3% were identified to have had an abnormal cardiac venous anatomy over the study period. There were 13 cases of persistent left side superior vena cava (pLSVC), 5 of which had coronary sinus ostium atresia (CSOA) including 2 with an 'unroofed' coronary sinus (CS); 1 patient had a unique anomalous origin of the CS and 1 patient had an isolated CSOA. In total 14 patients (60% repeat attempt) had successful percutaneous implant under general anaesthesia (46.7%) via the cephalic vein (59.1%), using the femoral approach (53.3%) for levophase venography and/or pull-through, including 1 case of endocardial LV implant. Pacing follow-up over 37.64±37.6 months demonstrated LV lead threshold between 0.62-2.9 volts (pulsewidth 0.4-1.5 milliseconds) in all cases; 5 patients died within 2.92±1.6 years of successful implant. CONCLUSION CRT devices can be implanted percutaneously even in the presence of substantial abnormalities of coronary venous anatomy. Alternative routes of venous access may be required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital, London, UK
| | | | - Idris Harding
- Department of Cardiology, St George's University Hospital, London, UK
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Royal Surrey County Hospital, Guildford, UK
| | - Abhay Bajpai
- Department of Cardiology, St George's University Hospital, London, UK
| | - Mark Norman
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Frimley Park Hospital, Surrey, UK
| | - Simon Pearse
- Department of Cardiology, St George's University Hospital, London, UK
| | - Ian Beeton
- Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
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