An Implantation of DDD Epicardial Pacemaker Through Ministernotomy in a Patient with a Superior Vena Cava Occlusion

Abstract

We successfully implanted a DDD epicardial pacemaker through a limited lower sternotomy in a patient whose superior vena cava had been occluded. Both epicardial leads were connected to the generator placed in the existing subcutaneous pocket on the left pectoral region through the second intercostal space. This approach provided excellent exposure and easy access to both the right appendage and the right ventricle. The combined procedure of epicardial DDD pacemaker implantation through a limited lower sternotomy with placement of the generator in the pectoral subcutaneous pocket is one of the better methods when intravenous lead implantation is difficult.

Surgical implantation of a biventricular pacing system via lower half mini sternotomy

“…Although median sternotomy provides a good access to the surface of all chambers of the heart, it may be unnecessary for a full sternotomy. The limited lower sternotomy technique described in the literature [8] only allows access to the right atrium and ventricle and not to the left side of the heart. For proper access to the left side of the heart, the mini sternotomy needs to go up to the level of the third intercostal space and then directed toward the left.…”

“…Surgical implantation of epicardial pacing leads is an option in children and adults who are not suitable for traditional transvenous approach. While median sternotomy is the common approach for implantation of an epicardial pacing system, other surgical approaches like left lateral thoracotomy [6], subcostal approach [7], limited lower sternotomy [8] and video-assisted thoracic surgery [1] have also been described. Although median sternotomy provides access to the surface of all chambers of the heart, it may be unnecessary for a full sternotomy.…”

“…With a left thoracotomy, access to the right side of the heart is restricted and with a subcostal approach difficulty arises if one attempts to implant a defibrillating patch. The limited lower sternotomy technique described in the literature [8] only allows access to the right atrium and ventricle and not to the left side of the heart. We present a case of surgical implantation of biventricular epicardial pacing leads and defibrillating patch via lower half mini sternotomy.…”

Implantation of an epicardial lead through minithoracotomy as an alternative for patients with leadrelated endocarditis who require permanent pacing

“…Sako et al [8] presented a case of DDD epicardial pacemaker implantation in the pectoral region through mini-sternotomy in a patient with superior vena cava occlusion. Systems implanted using this method are much less susceptible to infection than those implanted using traditional means.…”

Short-term Venous Patency after Implantation of Permanent Pacemakers or Implantable Cardioverter Defibrillators

“…1) Even if preoperative venography confirms the absence of vein occlusion or stenosis, we occasionally experience cases with long-term venous occlusion or stenosis due to permanent pacemaker or ICD implantation. [2][3][4][5][6] However, it has not yet been clarified which factors are associated with stenosis or occlusion of the vein containing the pacemaker leads. There is little information about post-implantation condition of veins in patients after permanent pacemaker or ICD implantation.…”