Two Leads in One Introducer Technique For A‐V Sequential Implantations

Abstract

BOGNOLO. D.A., ET AL.: Two leads in one introducer technique for A-V sequential implontations. Thirty-six [36} consecutive patients underwent implantation of transvenous atrioventricuJar sequential pacing systems by inserting the atriaJ and ventricuJar Jeads together tJirough one §14 French subclavian introducer. This technique has been easy, reliable and free of complications. (PACE, Vol. 5, March-April, 1982} sequential pacing, atriai leads, ventricular Jeads, subcJavian introducers This report describes our experience with the use of a single #14 French subclavian introducer for simultaneous passage of alrial and ventricular leads in thirty-six consecutive A-V sequential pacemaker implants. Material, Method and Operative TechniqueThe patient is placed on the operating table modified with the use of a plywood board, as previously described.' in marked Trendelenburg position in order to distend the suhclavian vein and prevent air embolism. A standard infraclavicular incision is made, and the suhclavian vein is punctured hy standard technique through the incision using a thin-walled #18 gauge needle. A flexible pigtail guide wire is advanced through the needle into the superior vena cava. By steady forceful pushing, a #14 French introducer with a tapered vessel dilator is advanced into the subclavian vein. After removing the dilator and guide wire, the exposed portion of the peel-away introducer sheath is pinched in order to prevent blood loss and air aspiration. A tined atriai "J" lead with a polyurethane insulator (Medtronic* 6990U) is first introduced and advanced far enough to reach the right atrium; the second lead, a ventricular tined polyurethane lead (Medtronic 6972], is Address for reprints: Diego A.

Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation

“…The passage of two electrodes down one sheath reduces the risk of making two separate punctures. 77,78 However, the large sheath may increase the risk of substantial air embolism and blood loss. In our experience, there is also frequent frustration from lead interaction, entanglement, and dislodgment.…”

“…77 This is less desirable than subclavian, axillary, or cephalic vein placement because of the greater risk for lead fracture and the potential for erosion. An acute bend must be created in the lead after it exits the venous structure and is brought down to the pacemaker pocket under or over the clavicle.…”

Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation in Adults

“…85,86 However, the large sheath may increase the risk of substantial air embolism and blood loss. 85,86 However, the large sheath may increase the risk of substantial air embolism and blood loss.…”

“…85 This is less desirable than subclavian, axillary, or cephalic vein placement because of the greater risk for lead fracture and the potential for erosion. 85 This is less desirable than subclavian, axillary, or cephalic vein placement because of the greater risk for lead fracture and the potential for erosion.…”