Abstract 45 Big data to compare peri-/postoperative complications of pacemaker implantation depending on venous access: cephalic vein cutdown versus subclavian puncture

Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Big data to compare peri-/postoperative complications of pacemaker implantation depending on venous access: cephalic vein cutdown versus subclavian puncture
F. Hasan¹, B. Lemke¹, M. Scholten², Z. Karosiene¹, S. Tulka³, S. Knippschild³, H. Bogossian⁴
¹Innere III - Klinik für Kardiologie, Elektrophysiologie und Angiologie, Märkische Kliniken GmbH, Lüdenscheid; ²Klinik für Anästhesie, Intensivmedizin, Schmerztherapie und Palliativmedizin, St. Vinzenz-Hospital, Dinslaken; ³Fakultät für Gesundheit /Lehrstuhl für Medizinische Biometrie und Epidemiologie, Universität Witten/Herdecke, Witten; ⁴Klinik für Kardiologie und Intensivmedizin, Evangelisches Krankenhaus Hagen Haspe, Hagen;
Purpose: The cephalic vein cutdown (CVC) and the subclavian puncture (SP) are the most used venous access for lead insertion of cardiac implantable electronic devices. The purpose of this study was to compare the peri-/postoperative complications for both approaches (CVC vs SP). Methods and results: A retrospective analysis of the quality assurance data of the state of North Rhine-Westphalia was performed to evaluate the peri/postoperative complications of first pacemaker implantation depending on the venous access. The data of pacemaker implantations from 2010 to 2014 for people who are at least 18 years old were evaluated. 139,176 pacemakers were implanted. 123,693 implantations were included in the study, the remaining 15483 were excluded from the study because both venous accesses (CVC and SP), different access, or a combination of several techniques were used. In 75,251 cases (60.8%) the pacemaker was implanted via CVC and in 48,442 cases (39.2%) the SP was used for lead insertion. The median age in both groups was 78 years. The implanted devices were mainly dual-chamber pacemakers (55,628 ~ 73.9% in the CVC group and 37,986 ~ 78.4% in the SP group), followed by single-chamber pacemakers VVI (18,733 ~ 24.9% in the CVC group and 9670 ~ 19.9% in the SP group). The proportion of CRT systems was low, only 0.3% in each group. The primary endpoint was defined as the occurrence of one of the following complications: asystole, ventricular fibrillation, pneumothorax, hemothorax, pericardial effusion, pocket hematoma, lead dislocation, lead dysfunction, postoperative wound infection, other complication requiring intervention. There were significantly fewer peri / postoperative complications in the CVC group compared to the SP group (1879/75,251 [2,49%] vs. 1765/48,442 [3,64%]; p-Value < 0,0001, odds ratio 1.47; Confidence intervall 1.38 , 1.57) Conclusion: The cephalic vein cutdown (CVC) as venous access for pacemaker implantation has significantly fewer peri/postoperative complications and should be used as the technique of the first choice.
https://dgk.org/kongress_programme/ht2021/P319.htm