Guidewire Technique Is Superior to Direct Insertion in Cephalic Cutdown Approach for the Dual Chamber Pacemaker Implantation

概要

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Background: Cephalic cutdown approach has advantage of avoiding complications associated withsubclavian puncture. When the cephalic vein (CV) is too small or too tortuous to accommodate leads, guidewire techniqueis reported to be useful. In this technique, the guidewire is placedthrough the openinginto the superior vena cava instead of the lead itself, and then the introducer and leadsare insertedas in a conventional subclavian approach. Purpose and Method: We compared the success rate of lead insertion byguidewire technique to the standard technique in patients who underwent dual chamber pacemaker implantation in our hospital. Patients with guidewire technique (GW-group) are recruited from consecutive 115 patients after introduction of this technique in August 2008, and standard group (S-group) consists of the previous 67 consecutive patients before August 2008. Results: Bothtwo leads were successfully inserted through the CV in 49 patients (45%) of the GW-group and 19 (21.9%) of the S-group (p=0.047). Only ventricular lead was inserted in 39 (35.8%) of the GW-group and 31 (48.4%) of the S-group (p=ns). No lead was inserted in 21 (19.2%) and 14 (29.7%), respectively. Only 1 case of the GW-group, which needed subclavian puncture, developed pneumothorax. Conclusion: In cephalic cutdown approach, guidewire technique can improve the success rate of dual leads insertion and avoid the risk of subclavian puncture.