Dwa problemy jednej procedury CIED: spasm AV i supresja SV, a może „nie ma tego złego, co by na dobre nie wyszło”

Abstract

Cardiac implantable electronic device (CIED) implantation procedures have become an indispensable part of treating the clinical manifestations of arrhythmias and/or heart conduction disorders. The first stage of CIED implantation involves the insertion of cardiac leads into the venous system via cephalic vein (CV) cutdown and/or axillary vein (AV) / subclavian vein (SV) puncture using special kits designated for this purpose. Similar techniques are used for central venous catheter (CVC) placement. Nonetheless, the course and effectiveness of this stage of the procedure may be affected by mediastinal vein anomalies, atypical venous morphometry and/or topography, reflex venospasm, and—in the case of the SV—the very fact of its coursing through the costoclavicular space. The rare coexistence of several unfavorable factors and the degree of such anomalies may sometimes prevent the originally planned approach, which happened in the case presented here.