What is the clinical evidence from this study?

Study design: Observational. Population: Revision of previously implanted pacemaker or automatic cardioverter defibrillator lead systems (n=23). Intervention: Axillo-subclavian venous imaging with gaseous carbon dioxide (CO2). Primary outcome: Significant venous occlusions.

What does this research mean for the field?

Axillo-subclavian venography with gaseous carbon dioxide is a safe and feasible method for identifying central venous occlusions prior to cardiac lead revisions when iodinated contrast is contraindicated. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To prospectively evaluate the feasibility, diagnostic utility, and safety of gaseous carbon dioxide venography for imaging the axillo-subclavian venous system prior to pacemaker or defibrillator lead revisions.

January 28, 2010Pacing and Clinical Electrophysiology

Utility and Safety of Axillo-subclavian Venous Imaging with Carbon Dioxide (CO2) Prior to Chronic Lead System Revisions

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Key result

Axillo-subclavian CO2 venography safely identifies significant venous occlusions in ~22% of device lead revisions.

n=23

Why the study?

Is axillo-subclavian venous imaging with carbon dioxide (CO2) safe and feasible for assessing venous patency prior to pacemaker or ICD lead revisions?

Population

23 consecutive individuals considered for revision of previously implanted pacemaker or automatic…

Design

Case_series

Authors

SWStephen L. WintersAmerican College of Cardiology JCJay H. CurwinCardiovascular Institute of the South JSJonathan SussmanRutgers, The State University of New Jersey

Discussion

Member takes

Implication

May offer contrast-sparing venous imaging before lead revision; hypothesis-generating and requires prospective validation before practice change.

Key Points

To prospectively evaluate the feasibility, diagnostic utility, and safety of gaseous carbon dioxide venography for imaging the axillo-subclavian venous system prior to pacemaker or defibrillator lead revisions.
Prospective study of 23 consecutive patients evaluated for revision of previously implanted pacemaker or automatic cardioverter defibrillator leads.
Manual infusion of approximately 20 mL of CO2 through primed tubing into an ipsilateral vein at or above the antecubital fossa.
Digital subtraction imaging performed over the axillo-subclavian region, lower neck, and mediastinum, with formal evaluation by interventional radiologists and electrophysiologists.
Significant venous occlusions were identified in 5 of 23 patients (22%).
Among the 18 lead revisions performed, access utilized the patent ipsilateral vein in 14 patients, the contralateral subclavian system in 3 patients, and an epicardial approach in 1 patient.
Zero complications occurred during or following gaseous carbon dioxide venography.

Study Design

Type

Observational (n=23)

Structured PICO

Is axillo-subclavian venous imaging with carbon dioxide (CO2) safe and feasible for assessing venous patency prior to pacemaker or ICD lead revisions?

Population

23 consecutive individuals considered for revision of previously implanted pacemaker or automatic cardioverter defibrillator lead systems.

Exposure

Axillo-subclavian venous imaging with gaseous carbon dioxide (CO2) (~20 mL manually infused via primed injection tubing)

Outcome

Identification of venous occlusions and procedural complications from venographysafety

Axillo-subclavian venography with gaseous CO2 is a safe and feasible alternative to iodinated contrast for assessing central venous patency prior to rhythm control device lead revisions.

Cite This Study

Winters et al. (2010) conducted an observational in Revision of previously implanted pacemaker or automatic cardioverter defibrillator lead systems (n=23). Axillo-subclavian venous imaging with gaseous carbon dioxide (CO2) was evaluated on Significant venous occlusions. Axillo-subclavian venography with gaseous CO2 identified significant venous occlusions in 22% of patients undergoing device lead revisions, with no complications.

synapsesocial.com/papers/6aa65ba56b1ae6e96478fe3e https://doi.org/10.1111/j.1540-8159.2009.02680.x

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Implication

May offer contrast-sparing venous imaging before lead revision; hypothesis-generating and requires prospective validation before practice change.

Utility and Safety of Axillo-subclavian Venous Imaging with Carbon Dioxide (CO2) Prior to Chronic Lead System Revisions

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Utility and Safety of Axillo-subclavian Venous Imaging with Carbon Dioxide (CO2) Prior to Chronic Lead System Revisions

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

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