A Useful Technique for Cephalic and Axillary Vein Puncture during Pacemaker Lead Implantation: How to Insert a Pacemaker Lead Has Been Established?

概要

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6 years ago we had not devised for inserting a pacemaker lead and have done the way to puncture the subclavian vein twice during pacemaker implantation (group A). But to avoid complications at puncture and to prevent lead damage in costoclavicular angle, we are going to have the way to insert two leads from a different route extrathoracically. Our way is how to puncture the axillary and cephalic vein. While viewing the first guide wire inserted from cephalic vein under fluoroscopic, we puncture the axillary vein and insert the second guide wire (group B). This success rate of our way is about 80%. There was no complication in operation until now. The number of the inserted leads during this period was 524 for 24 years. We made a statistical comparison between the two groups. The number of lead failure was 28 (10.3%) out of 272 in group A and 0 (0%) out of 252 in group B (P<0.0001, Kruskal-Wallis test). The mean follow-up years of group A and B were about 9.4 and 2.5 years. Expected number of lead failure in group A after 2.5 years was 1.0. But the actual number of lead failure in group B was 0. These results indicate that Group B was expected to be an effective method.