Key result
Contralateral subclavian lead placement enables successful AV sequential pacing upgrade when ipsilateral veins are inaccessible.
Why the study?
Patients with pacemaker syndrome requiring AV sequential pacing may have inaccessible venous systems on the side of their original transvenous pacemaker placement, necessitating alternative approaches for atrial electrode placement.
Does the use of the contralateral subclavian vein for atrial electrode placement allow for successful AV sequential pacing in patients with pacemaker syndrome and inaccessible ipsilateral venous systems?
Case Report (n=2)
Does the use of the contralateral subclavian vein for atrial electrode placement allow for successful AV sequential pacing in patients with pacemaker syndrome and inaccessible ipsilateral venous systems?
The contralateral subclavian vein can be successfully used for atrial electrode placement and tunneled to the original pacemaker pocket in patients requiring AV sequential pacing who have inaccessible ipsilateral venous systems.
Answers are grounded in this paper and cite their sources.
Contralateral subclavian atrial lead placement may be feasible when ipsilateral access is lost; case reports leave open questions of safety, durability, and clinical adoption.
Two patients with documented pacemaker syndrome were referred for AV sequential pacing and were found to have inaccessible venous systems on the side of their original transvenous pacemaker placement. The contralateral subclavian vein was subsequently catheterized with an atrial electrode using the sheath-set technique. Then the proximal aspect of the atrial endocardial lead was tunneled to the original pacemaker pocket. Once accomplished, both (atrial and ventricular) leads were connected to an AV sequential pulse generator. The united pulse generator and lead were reinserted in the original pacemaker pocket.
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Peter H. Belott (1983) conducted a case report in Pacemaker syndrome with inaccessible venous systems (n=2). Placement of atrial electrodes via the contralateral subclavian vein was evaluated. In two patients with pacemaker syndrome and inaccessible ipsilateral veins, the contralateral subclavian vein was successfully used to place an atrial electrode for AV sequential pacing.
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