New introducer technique for implanting pacemakers and defibrillator leads: percutaneous incannulation of the cephalic vein.

OBJECTIVES: This study was designed to assess the feasibility of percutaneous incannulation of cephalic vein for the implantation of pacemaker and defibrillator leads.

BACKGROUND: The development of the subclavian vein puncture technique for pacemaker lead implantation has many advantages compared to surgical isolation of cephalic vein. However, initial enthusiasm has been dampened by reports of serious complications because of the anatomical relationships of the subclavian vein.

METHODS AND RESULTS: Percutaneous incannulation of the right cephalic vein was attempted in 75 patients who were candidates for permanent pacemaker or ICD implantation. The technique was effective in 46 patients. It was shown to be ineffective in 18, despite the presence of a normal vein. In seven patients, the cephalic vein was found to be unusable for passing the electrocatheter and in four patients, the vein was absent. In the patients in whom the vein was present, the success rate was 46/71 (64%). The average implantation time was 7.2 minutes (range 5-10), while the average time for conventional surgical technique was 15.2 minutes (range 14-20) (p < 0.001). All patients remained free from complications during a mean follow-up period of 8.2 months (range 1 to 18).

CONCLUSIONS: In our opinion, percutaneous incannulation of cephalic vein could be adopted as the first step in pacemaker or defibrillator implantation procedures, as it shows satisfactory success rates, simplicity of execution and absence of complications. Most importantly, in the event of failure, it does not compromise the use of a conventional technique.