Novel extrathoracic puncture techniques for pacemaker lead insertion: Pitfalls of the conventional extrathoracic puncture method

Introduction: Surgical procedures for pacemaker implantation vary among facilities. The extrathoracic venous puncture method has been utilized for lead insertion, although patients' body movements can displace the targeted vein from the area into which a contrast agent has been injected for imaging. Failed punctures cause edema around the puncture site, spasm, or venous collapse due to bleeding, which may render another puncture impractical. To overcome these problems, we report a new technique for the extrathoracic puncture method. Methods and results: From April 2007 through March 2011, we performed 35 new dual chamber pacemaker implantation procedures. This study compared a conventional puncture group (from April 2007 through March 2009; Group A) with a catheter-guided puncture group (from April 2009 through March 2011; Group B). We analyzed procedure time and procedure-related complications in each group. The procedure time was 138.6±41.8 min in the conventional puncture group (Group A) and 109.8±23.2 in the catheter-guided puncture group (Group B). There was a significant reduction in the procedure time in the catheter-guided puncture group (Group B) compared with the conventional puncture group (Group A; p=0.016). No patients in either group had pneumothorax, hematoma, or any other complications. Conclusion: Our puncture method involving catheter insertion appears to be safe and effective.