TY - JOUR
T1 - Clinical predictors of successful cephalic vein access for implantation of endocardial leads
AU - Knight, Bradley P.
AU - Curlett, Kristen
AU - Oral, Hakan
AU - Pelosi, Frank
AU - Morady, Fred
AU - Strickberger, S. Adam
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2002/10
Y1 - 2002/10
N2 - Background: The purpose of this study was to determine whether there are any patient characteristics that predict successful use of the cephalic vein for endocardial lead implantation. Methods: One-hundred fifty consecutive patients who underwent implantation of one or more endocardial pacemaker (N = 63) or defibrillator (N = 87) leads using a cephalic vein approach were included in this prospective study. The mean age of the patients was 63 ± 14 years, and 115 (77%) were men. Ninty-one patients (61%) had coronary artery disease, 77 patients (51%) had hypertension, and 42 patients (28%) had diabetes. The mean ejection fraction was 0.34 ± 0.17. Results: At least one lead was successfully implanted using a cephalic vein approach in 96 patients (64%). The most common reason for failure of the cephalic vein approach was a small cephalic vein, found in 25 patients (17%). Independent predictors of successful cephalic vein use were diabetes (p < 0.001), ejection fraction ≤0.40 (p < 0.05), and male gender (p < 0.05). At least one endocardial lead was implanted in 19 of the 24 (79%) men who had an ejection fraction ≤0.40 and diabetes, compared to 4 of the 11 (36%) women who had an ejection fraction >0.40 and did not have diabetes. The only independent predictor of successful cephalic vein implantation among nondiabetics was an ejection fraction ≤0.40 (p < 0.01). Body size was not an independent predictor of successful cephalic vein use. Conclusion: Baseline patient characteristics influence the likelihood of successful endocardial lead implantation using a cephalic vein approach. Diabetes, ventricular dysfunction, male gender and are associated with an increased likelihood of a successful implant using the cephalic vein. Smaller leads and and better techniques are needed to improve the success rate of cephalic vein implantion in all patients.
AB - Background: The purpose of this study was to determine whether there are any patient characteristics that predict successful use of the cephalic vein for endocardial lead implantation. Methods: One-hundred fifty consecutive patients who underwent implantation of one or more endocardial pacemaker (N = 63) or defibrillator (N = 87) leads using a cephalic vein approach were included in this prospective study. The mean age of the patients was 63 ± 14 years, and 115 (77%) were men. Ninty-one patients (61%) had coronary artery disease, 77 patients (51%) had hypertension, and 42 patients (28%) had diabetes. The mean ejection fraction was 0.34 ± 0.17. Results: At least one lead was successfully implanted using a cephalic vein approach in 96 patients (64%). The most common reason for failure of the cephalic vein approach was a small cephalic vein, found in 25 patients (17%). Independent predictors of successful cephalic vein use were diabetes (p < 0.001), ejection fraction ≤0.40 (p < 0.05), and male gender (p < 0.05). At least one endocardial lead was implanted in 19 of the 24 (79%) men who had an ejection fraction ≤0.40 and diabetes, compared to 4 of the 11 (36%) women who had an ejection fraction >0.40 and did not have diabetes. The only independent predictor of successful cephalic vein implantation among nondiabetics was an ejection fraction ≤0.40 (p < 0.01). Body size was not an independent predictor of successful cephalic vein use. Conclusion: Baseline patient characteristics influence the likelihood of successful endocardial lead implantation using a cephalic vein approach. Diabetes, ventricular dysfunction, male gender and are associated with an increased likelihood of a successful implant using the cephalic vein. Smaller leads and and better techniques are needed to improve the success rate of cephalic vein implantion in all patients.
KW - Cardiac pacing
KW - Cephalic vein
KW - Defibrillation
KW - Defibrillator
KW - Endocardial leads
KW - Pacemaker implantation
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U2 - 10.1023/A:1020893923079
DO - 10.1023/A:1020893923079
M3 - Article
C2 - 12397228
AN - SCOPUS:0036817817
SN - 1383-875X
VL - 7
SP - 177
EP - 180
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -