Sex-based outcomes of subcutaneous implantable cardioverter-defibrillator and impact of surgical technique

Procedural and long-term outcomes of tunneled transvenous leads

BACKGROUND

Lead-related venous stenosis and occlusion can complicate the insertion or replacement of transvenous leads in patients with cardiac implantable electronic devices (CIEDs). A possible solution is to tunnel the lead from the contralateral vasculature to the ipsilateral generator. Procedural complications and long-term outcomes remain unclear with this technique.

OBJECTIVE

We sought to assess outcomes of tunneled transvenous leads.

METHODS

We retrospectively identified all patients who underwent transvenous CIED lead tunneling to a contralateral pocket at our institution between 2014 and 2024. Clinical characteristics, indications for lead implantation, postoperative complications, and long-term outcomes were collected.

RESULTS

We identified that 27 patients underwent transvenous lead tunneling at our institution. Most patients were men (20, 74%) with a mean age of 68.8 ± 18.3 years. Most patients had nonischemic cardiomyopathy (16, 59%) with a mean ejection fraction of 29.3% ± 11.3%. The tunneled leads were coronary sinus leads (20, 74%), followed by defibrillator leads (5, 18.5%) and right ventricular pacing leads (2, 7.4%). Implantation procedures were primarily for device upgrade (18), lead revisions (8), or de novo lead placement (1). No postoperative complications were seen. Patients were followed for a mean of 2.2 ± 1.4 years. One tunneled defibrillator lead (3.7%) had low shock impedance 3 years after implantation, which was monitored and did not require an intervention.

CONCLUSION

In patients with ipsilateral venous occlusion, contralateral lead tunneling appears to be an effective and safe approach to manage patients with CIEDs and occluded ipsilateral subclavian veins.