Vasoconstrictive responses of the cephalic vein during first-time cardiac implantable electronic device placement.

BACKGROUND

During cardiac implantable electronic device (CIED) implantation procedures cardiac leads have been mostly introduced transvenously. The associated injury to the selected vessel and adjacent tissues may induce reflex vasoconstriction. The aim of the study was to assess the incidence of cephalic vein (CV) vasoconstriction during first-time CIED implantation.

MATERIALS AND METHODS

Of the 146 evaluated first-time CIED implantation procedures conducted in our centre in 2016, we selected those during which CV vasoconstriction was recorded. We focused on the stage of the procedure involving CV cutdown and/or axillary vein (AV)/subclavian vein (SV) puncture for lead insertion. Only cases documented via venography were considered.

RESULTS

Vasoconstriction was observed in 11 patients (5 females and 6 males, mean age 59.0 ± 21.2 years). The presence of this phenomenon affected the stage of CIED implantation involving cardiac lead insertion to the venous system, in severe cases, requiring a change of approach from CV cutdown to AV/SV puncture. The extent of vasoconstriction front propagation was limited to the nearest valves. Histological examinations of collected CV samples revealed an altered spatial arrangement of myocytes in the tunica media at the level of leaflet attachment.

CONCLUSIONS

Cephalic vein vasoconstriction is a rare phenomenon associated with accessing the venous system during first-time CIED implantation. The propagation of CV constriction was limited by the location of the nearest valves.