Abstract 2436: Comparison of a Novel Axillary Technique versus a Standard Infraclavicular Approach for Endocardial Devices in Pediatric and Congenital Heart Disease Patients
Introduction The purpose of this study is to describe a novel technique for pacemaker or internal cardioverter defibrillator (ICD) implantation and to evaluate outcomes in patients with this technique compared to patients with the standard infraclavicular approach.
Methods and Results The novel axillary technique involves a small infraclavicular incision for placement of the leads, and a second incision high in the axilla for placement of the device. The larger incision and contour of the device are therefore hidden under the arm, providing an improved cosmetic result. Between 2001–2008, 49 patients with new endocardial axillary devices and 16 with infraclavicular were identified. Patient demographics were similar between groups. All devices were implanted successfully with no procedural complications. More patients in the axillary group had dual chamber devices. During the study period, reintervention was necessary for fracture or infection in 14% (7/49) of patients in the axillary group versus 13% (2/16) in the infraclavicular group. Lead fractures occurred in 3 atrial and 4 ICD leads in the axillary group compared with 1 atrial and 1 ICD lead in the infraclavicular group. All ICD fractures were Fidelis leads. The median time for atrial or ventricular lead failure was 12 (6 – 41) months. Two infections occurred in the axillary group, one following the initial implant and one following a lead extraction for lead fracture. There were no infections in the infraclavicular group.
Conclusions The novel axillary approach offers improved cosmetic results with similar lead longevity and complication rates to the standard infraclavicular approach. Longer term follow-up is necessary to fully evaluate patient outcomes.