P988Cephalic vein anatomy variations for pacemaker implantation

Background: Antiarrhythmic device implantation using the cephalic vein (CV) cutdown technique (CT) is considered to be superior to the conventional subclavian vein puncture (SVP) with regards to the incidence of perioperative complications. However, lead placement is sometimes difficult due to abnormal CV anatomy in deltopectoral groove. Objectives: to evaluate the influence of cephalic vein anatomy variations on pacemaker (PM) implantation results. Methods: 94 pts (55 females) aged 23-93 yo were included into the study. Pts were divided into two groups (1:1). Group I (n=47; 24 females): angiography of CV via cubital vein had been performed before PM implantation. In this group approach for device placement had been chosen based on CV anatomy: CT or SVP. Type of PM in group I: single chamber device – 17 pts (36%), dual chamber device – 30 (64%). Group II (n=47; 31 females): PM implantation had been performed without angiography of CV. Type of PM in group II: single chamber device – 21 (45%), dual chamber devices – 26 (55%). There were no significant differences in baseline characteristic in both groups. In all cases were no any contraindications to intravenous contrast administration. Fluoroscopy time, length of procedure and complications were evaluated. To evaluate the relationship between CV anatomy and success rate of CT the contingency tables were used. Results: Fluoroscopy time and length of procedure in group I were less than in group II (p=0.000225 и p=0.000001 respectively). Four type of CV anatomy were found. I type (n=22; 46.8%) - angle of cephalic-axillary confluence (L) less than 900, II type (n=9; 19.2%) – L - 900, III type (n=11; 23.4%) – L>900, IV type (n=5; 10.6%) – dichotomous type of CV. Significant correlation between type of CV anatomy and success rate of leads placement via CV was found (χ2 = 30,98; df = 3, p < 0.0001, Cramer’s V = 0.811). Thus, in I type of CV anatomy lead had been placed via CV in all cases. In II type leads had been placed via CV in 4 pts (44%). In III and IV type placement of leads via CV had been failed in all cases. In this cases leads were placed using SVP. Complications: Group I - pocket hematoma (n=4; 9%), Group II - pneumothorax (n=1; 2%). Conclusion: Understanding of CV anatomy before PM implantation leads to decrease of fluoroscopy time and length of procedure. Evaluation of CV anatomy is useful option for choosing approach for PM implantation.