Acute and long-term feasibility of contralateral transvenous lead placement with subcutaneous, pre-sternal tunnelling in patients with chronically implanted rhythm devices.

AIMS: A growing number of patients with implanted rhythm devices require new or additional leads, e.g. in cases of electrode defect or planned device upgrade. If the ipsilateral subclavian vein is occluded, transvenous electrode placement from the contralateral side with subcutaneous, pre-sternal lead tunnelling (TUN) is one potential option that has been described in anecdotal reports. The aim of this retrospective study was to determine the acute and long-term feasibility of this approach.

METHODS AND RESULTS: We identified 18 subjects (67% male, 66±14 years) who underwent TUN at our institution between the years 1995 and 2009. Implantation protocols and patient files were reviewed for peri-operative complications and long-term lead performance. Furthermore, patients were interviewed for symptoms related to the tunnelled lead. Twenty transvenous leads (seven implantable cardioverter defibrillator leads; five left ventricular, four right ventricular, four right atrial pace/sense electrodes) were successfully tunnelled without significant peri-operative complications. The follow-up duration was 29±36 (3-162) months. Electrical parameters remained stable in 95% (19/20) of the tunnelled leads. In one right ventricle pace/sense lead, ventricular oversensing was documented 10 months after TUN, and the lead was replaced because a structural defect could not be excluded. Five patients died without causal relationship to the procedure 4-48 months after TUN. One patient reported discomfort related to the tunnelled lead.

CONCLUSION: Contralateral transvenous lead implantation with subcutaneous, pre-sternal TUN appears to be a feasible option in selected patients with an implanted rhythm device and ipsilateral subclavian vein occlusion.