Lower incidence of venous thrombosis with temporary active-fixation lead implantation in mobile patients.

AIMS: Temporary transfemoral cardiac pacing is widely accepted, but is associated with high incidence of asymptomatic deep vein thrombosis (DVT), which in turn is associated with restricted patient mobility. The passive-fixation lead typically used in this procedure restricts patient mobility during implantation. METHODS AND RESULTS: An active-fixation lead allowing normal ambulation was prospectively assessed in 47 consecutive patients. Prior to explantation, venous duplex ultrasound was performed to determine DVT incidence, with the contralateral leg as control. To reduce possible false negatives, ventilation/perfusion scintigraphy was also performed (n = 42). Patient mobility during implantation was classified as high (n = 29), moderate (n = 6), or low (n = 12). Anticoagulants were limited to cases meeting standard guidelines. Asymptomatic DVT was diagnosed in three patients (6.4%), compared with 25-39% reported using standard passive-fixation leads. Furthermore, all of these patients had low mobility during the implantation period. No post-implantation lung scan showed high probability of pulmonary embolism. CONCLUSION: In the 75% of patients with moderate or high mobility, there were no DVT cases. The 6.4% DVT incidence was limited to patients with low mobility and was significantly lower than the norm for this procedure. A larger, randomized study is needed to confirm the benefits of the mobility allowed by an active-fixation lead.

Permanent transfemoral pacemaker: a single-center series performed with an easier and safer surgical technique.

INTRODUCTION: When venous access via the upper venous tree is not possible, the usual approach is to proceed to epicardial lead placement. MATERIAL AND METHODS: This report presents a consecutive series of 12 permanent pacemaker systems utilizing the right femoral vein for venous access implanted between May 2001 and October 2004. RESULTS: A modification of the previously reported surgical technique was used with a mean implant time of 52 minutes. Five were dual-chamber systems and seven were VVIR. All the leads implanted were active fixation. There was a 0% dislodgment rate and a mean follow-up of 18 months. During this time, three patients required revision or treatment of a pocket complication. All systems remained in the pacing mode as originally programmed with stable low sensing and pacing thresholds. There was no clinical evidence for acute or chronic venous thrombosis and no evidence of asymptomatic venous obstruction in eight patients who underwent echo-duplex studies. CONCLUSION: We believe that the permanent femoral implant utilizing the technical modifications described in this article, offers an alternative to epicardial lead placement when the usual upper venous tree access is not available.