PT002 Comparison of invasive haemodynamics, Brain Natriuretic Peptide and high sensitivity Troponin T levels with right ventricular apical and right ventricular outflow tract pacing in normal hearts

Abstract

Introduction: The data about the incidence of subclavian venous (SCV) obstruction or thrombosis after transvenous device implantation is limited and it is rare following immediate period after the implantation. However, when it is neccesary to substitute defected leads or improve the funcional status by making a device upgrade, the presence of obstruction or severe stenosis can make the intervention difficult, forcing to use the opposite side to implant the new device. Objectives: We aimed to assess the incidence of venous obstruction or severe stenosis and its tortuosity after a pacemaker or ICD implantation in our population. We obtained an iodinated contrast venography study just before the elective device’s replacement due to battery discharge. Methods: A contrast venography was performed in 26 patients who were candidates to elective generator change due to battery discharge. 16 p (64%) were men, the main age was 77 11 years; 13p (50%) had Chronic Heart Failure and in 18p (72%) Ischemic cardiomyopathy was diagnosed. The mean period between the first implant and device’s replacement was 9,3 3,4 years. 17p (68%) had Diabetes Mellitus, 15p (60%) were Hypercholesterolemic, 9p (36%) were smokers and 11p (44%) were had systemic arterial hypertension. Results: The initial indication to implantation the device was AuriculoVentricular block in 11p (42%), sinus node dysfunction in 8p (32%), resynchronization therapy with or without ICD in 5p (20%), and prevention of sudden death without resynchronization therapy in 1p(4%). The generator was DDD in 11p (44%), VDD in 2p (8%), VVI in 6p (24%)%, CRT in 4p (16%), and CRT-ICD in 2p (8%). The Right Ventricular lead was implanted in the outflow tract in 14p (56%) and in 11p(44%) the site was the right ventricular apex. In 100% of the patients the leads were implanted through the Left Subclavian Vein. Venous severe stenosis or obstruction was observed with venographic study in 4p (16%) and tortuosity in 2p(8%). We didn’t find any predictor of severe stenosis or obstruction of the access veins. Conclusion: Severe stenosis, obstruction or tortuosity of the access veins after a pacemaker or ICD implantation make difficult futures upgrades and leads change. The process can be facilitated by means of doing a previous venography. In our population it is unusual in an intermediate-long term period Disclosure of Interest: None Declared