PO-02-108 VENOPLASTY CAN BE PERFORMED SAFELY AND SUCCESSFULLY IN PATIENTS WITH SUBTOTAL AND TOTAL VENOUS OCCLUSION NEEDING ADDITIONAL TRANSVENOUS ELECTRODES

Abstract

Lead failure, but also upgrade procedures from pacemaker to implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) can be hampered by venous obstruction occurring in 10-25% of patients with prior transvenous electrodes. A relatively underused technique to overcome venous obstruction is a percutaneous venous dilation procedure (venoplasty). We aimed to identify the feasibility of venoplasty procedures in two Dutch tertiary referral centers. 101 consecutive patients where venoplasty was attempted were included in the study and baseline parameters as well as procedural characteristics and complications were recorded. 47% of patients needed replacement of a defective electrode and 53% an upgrade to CRT or from pacemaker to ICD. Venous stenosis was defined as significant (70-90%), subocclusive (90-99%) and occlusive (100%) and the region was divided into three segments: subclavian vein, brachiocephalic vein and junction to the vena cava superior. The study included 39 pacemaker and 62 ICD patients, 69±12 years old, 81% were male. Body mass index was 26±4, left ventricular ejection fraction 33±13% and eGFR 64±24ml/min/1,73m2. At the time of the procedure, 2,0±0,8 electrodes were present and 1,2±0,2 electrodes were added, in 16% atrial, 50% RV and 51% LV electrodes. The procedures took 135±56 minutes and fluoroscopy dose was 5078±5482μGy/m2. There were 87 total occlusions of any segments and in addition, 49 subocclusive lesions needing venoplasty (table). 9 procedures were unsuccessful (9%), mostly due to failure to pass the occlusion. 3 patients (3%) had pocket hematoma not needing reintervention and one patient (1%) needed lead repositioning due to dislocation. There was no damage to any existing lead during the procedures. 91% of patients had a successful procedure without a complication needing reintervention. Venoplasty is safe in subocclusive and occlusive venous stenosis and can be performed with high success using modern material potentially avoiding lead extraction or contralateral tunneling procedures.Tabled 1Patient population (N=101)TimeProcedure duration, min134 ± 56Fluoroscopy time, min37 ± 26Fluoroscopy dose, μGy/m25078 ± 5482Degree of stenosis70-90%, % (n)5 (5)90-99%,% (n)18 (18)100%, % (n)35 (35)Brachiocephalic vein70-90%, % (n)5 (5)90-99%,% (n)14 (14)100%, % (n)30 (30)Brachiocephalic to VCS junction/VCS70-90%, % (n)2 (2)90-99%,% (n)17 (17)100%, % (n)22 (22)Success and complicationsSuccessful venous access, % (n)92 (93)Successful procedure, % (n)91 (92)Pneumothorax, % (n)0 (0)Pocket hematoma, % (n)3 (3)With reintervention, % (n)0 (0)Bleeding, % (n)0 (0)Pericardial effusion/tamponade, % (n)0 (0)Thromboembolic complications, % (n)0 (0)Lead dislocation, % (n)1 (1)With reintervention, % (n)1 (1)Infection, % (n)0 (0)Total complications*, % (n)9 (9)*composite of complications needing re-intervention and unsuccesful procedures Open table in a new tab