Key result
Leadless pacemakers cut pocket and lead complications vs transvenous pacing despite higher initial perforation risk.
Why the study?
Surgical epicardial lead placement is a last resort for permanent pacing but is limited by reduced reliability compared with transvenous leads, necessitating alternative approaches for patients with limited venous access.
Surgical lead placement is generally considered as a last resort for patients who require permanent pacing and who are unable to accommodate transvenous leads. The technique is limited by the need for direct epicardial access and reduced reliability of epicardial leads (compared with modern transvenous leads) [Belott and Reynolds. Permanent pacemaker and implantable cardioverter defibrillator implantation. In Ellenbogen KA, Kay GN, Lau CP, Wilkoff BL (eds). Clinical Cardiac Pacing, Defibrillation, and Resynchronization Therapy. Philadelphia: Saunders Elsevier, 2007; pp. 561-651]. We report a patient with limited venous access and a poorly functioning epicardial ventricular lead, who was successfully upgraded to a dual-chamber endocardial pacing system via the iliac vein. Pacemaker lead implantation from the iliac vein is an often overlooked option for patients with limited central venous access. In our patient, a pacing upgrade was achieved after the presumptive final option had been exhausted.
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Gupta et al. (2008) conducted a review in Bradycardia and conditions requiring cardiac pacing. Leadless cardiac pacing vs. Transvenous cardiac pacing was evaluated. Leadless pacemakers offer an effective alternative to transvenous pacing by significantly reducing pocket and lead-related complications, despite carrying a higher initial risk of procedure-related cardiac perforation.
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