Abstract 8544: Axillary Vein is a Better Access than Subclavian Vein or Cephalic Vein with Respect to Long-Term Pacemaker Lead Survival

Purpose: To investigate the relationship between venous access and long-term pacemaker lead failure (PLF) Methods: This is a retrospective cohort study. Case records of 409 patients (221 women, mean age 72.2±10.5 years) undergoing pacemaker implantation in 2 hospitals in the period between January 2000 and December 2004 were reviewed. PLF was defined as abnormal impedance and/or high pacing threshold and/or low sensing threshold leading to replacement or abandonment of the lead. Results: A total of 682 (274 atrial and 408 ventricular) leads were implanted with contrast-guided axillary vein puncture (AP, 252), subclavian vein puncture (SP, 212) or cephalic vein cutdown (CP, 218). Over a mean follow-up of 73.7±33.2 months, 25 PLF were documented. Three (1.2%) were in AP group, 9 (4.1%) were in CP group and 13 (6.1%) were in the SP group. Using Cox regression, only the use of AP (RR=0.25, 95% CI 0.07-0.92; p=0.037), but not the other variables (age, sex, aetiology of bradycardia, cardiac chamber of lead implantation, lead size, lead material and lead fixation mechanism) was an independent predictor of PLF. With Kaplan-Meier analysis, AP results in significantly less PLF than SP (p=0.013) or CP (p=0.047). Conclusions: The use of AP is an independent predictor of PLF. AP results in less PLF than SP or CP.