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Safe and Effective Placement of Two Bipolar Silicone Leads in the Cephalic Vein Using a Hydrophilic Guidewire and a Split Introducer
Author(s) -
COSTA A.,
FAURE E.,
ROMEYER C.,
SAMUEL B.,
MESSIER M.,
LAMAUD M.,
ISAAZ K.
Publication year - 2000
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2000.tb00777.x
Subject(s) - medicine , cephalic vein , subclavian vein , surgery , venous access , lead (geology) , artificial cardiac pacemaker , dilator , anesthesia , vein , catheter , geomorphology , geology
The cephalic vein (CV) is preferable to the subclavian vein for implanting permanent pacing leads because of fewer complications. Unfortunately, this access is unusable in a substantial number of patients. This prospective study evaluates a technique to increase CV access for the placement of two silicons bipolar leads used in DDD pulse generator implants. A standard cephalic cutdown was performed under local anesthesia and a hydrophilic guidewire (HGW) threaded in the CV. The first (ventricular) bipolar lead was then introduced and positioned. When possible, introduction of the second (atrial) lead followed the same direct access. A failed introduction led to a modified procedure (MP) relying on a “split” introducer (8–9 Fr Plastimed) advanced with a circular motion over the HGW, then removal of the dilator, removal of the HGW, insertion of the pacing lead into the sheath with placement in the right atrium, followed by sheath withdrawal. Over an 18‐month period, 90 consecutive patients had DDD pacemakers implanted. The CV was accessible in 76 (84.5%) of 90 patients and the direct introduction of the ventricular lead was obtained in 74 (97.4%) of these. Atrialization proceeded as follows: direct access CV in 14 (18%) of 76 patients, MP access in 54 (71 %) of 76 patients, and MP failure in 8(11 %) of 76 patients. Overall, this approach allowed cephalic dual insertion in 68 (89%) of 76 patients. In conclusion, the modified procedure presented in this study allows a dual catheteriza‐tion with bipolar leads in 89% of patients when a CV is available. This significantly improves the success rate for dual bipolar lead implants in this configuration.