Procedural and Long-Term Outcomes of Tunneled Transvenous Leads

Abstract

Lead-related venous stenosis and occlusion can complicate the insertion or replacement of transvenous leads in patients with cardiac implantable electronic devices (CIED). A possible solution is to tunnel the lead from the contralateral vasculature to the ipsilateral generator. Procedural complications and long term outcomes remain unclear with this technique. We sought to assess outcomes of tunneled transvenous leads. We retrospectively identified all patients who underwent transvenous CIED lead tunneling to a contralateral pocket at our institution between 2014 and 2024. Clinical characteristics, indications for lead implant, post-operative complications and long-term outcomes were collected. We identified 27 patients underwent transvenous lead tunneling at our institution. Most patients were males (74%) with an average age of 68.8 ± 18.3 years old. Most patients had non-ischemic cardiomyopathy (59%) with an average ejection fraction of 29.3 ± 11.3 %. The tunneled leads were coronary sinus leads (20), followed by defibrillator leads (5) and RV pacing leads (2). Implants were primarily for device upgrade (18), lead revisions (8), or de-novo lead placement (1). No post-operative complications were seen. Patients were followed for an average of 2.2 ± 1.4 years. One tunneled defibrillator lead (3.7%) had low shock impedance 3 years after implant which was monitored and did not require an intervention. In patients with ipsilateral venous occlusion, contralateral lead tunneling appears to be an effective and safe approach to manage CIED patients with occluded ipsilateral subclavian veins.