Comparison of the Axillary Venous Approach and Subclavian Venous Approach for Efficacy of Permanent Pacemaker Implantation – 8-Year Follow-up Results –

Ki-Hun Kim; Kyoung-Min Park; Gi-Byoung Nam; Dae-Kyeong Kim; Minkyung Oh; HyungOh Choi; Taek Jong Hong; Bo-Min Park; Guang-Won Seo; Pil-Sang Song; Dong-Kie Kim; Sang-Hoon Seol; Doo-IL Kim; You-Ho Kim; Kee-Joon Choi

doi:10.1253/circj.CJ-13-0884

Arrhythmia/Electrophysiology

Comparison of the Axillary Venous Approach and Subclavian Venous Approach for Efficacy of Permanent Pacemaker Implantation

– 8-Year Follow-up Results –

Ki-Hun Kim, Kyoung-Min Park, Gi-Byoung Nam, Dae-Kyeong Kim, Minkyung Oh, HyungOh Choi, Taek Jong Hong, Bo-Min Park, Guang-Won Seo, Pil-Sang Song, Dong-Kie Kim, Sang-Hoon Seol, Doo-IL Kim, You-Ho Kim, Kee-Joon Choi

Author information

Ki-Hun Kim
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine
Kyoung-Min Park
Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine
Gi-Byoung Nam
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
Dae-Kyeong Kim
Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine
Minkyung Oh
Department of Pharmacology, Clinical Trial Center, Inje University College of Medicine
HyungOh Choi
Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine
Taek Jong Hong
Department of Internal Medicine, Busan National University Hospital, Busan University College of Medicine
Bo-Min Park
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine
Guang-Won Seo
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine
Pil-Sang Song
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine
Dong-Kie Kim
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine
Sang-Hoon Seol
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine
Doo-IL Kim
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine
You-Ho Kim
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
Kee-Joon Choi
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine

Keywords: Lead complications, Pacemakers, Veins

JOURNAL FREE ACCESS

2014 Volume 78 Issue 4 Pages 865-871

DOI https://doi.org/10.1253/circj.CJ-13-0884

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Abstract

Background: Long-term data on lead complication rates are limited for both the axillary and subclavian venous approaches for permanent pacemaker implantation. Methods and Results: We conducted a single-center, retrospective, nonrandomized comparison. We reviewed the patients who had consented to receiving a permanent pacemaker implant. A superficial landmark or radiographic contrast guiding was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. From January 1992 to December 2005, we analyzed 1,161 permanent pacemaker leads in 655 patients [subclavian venous approach (group I: 338 patients, 542 leads) and axillary venous approach (group II: 317 patients, 619 leads)]. Baseline characteristics of the patients did not differ. However, DDD-pacemakers and atrial leads were used more often in group II than in group I (94% vs. 62% and 49% vs. 40%, P<0.01). During the 8-year follow-up, lead complication rates were lower in group II (17 leads, 3%) than in group I (31 leads, 6%) (P=0.03), and group II had a better complication-free survival curve than group I with a 49% relative risk reduction in lead complication rates (hazard ratio =0.51; 95% confidence interval, 0.27–0.94; P=0.03). Conclusions: The axillary venous approach for permanent pacemaker implantation has better long-term efficacy and lower lead complication rates than the subclavian venous approach. (Circ J 2014; 78: 865–871)

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