SUBCLAVIAN CRUSH SYNDROME COMPLICATING TRANSVENOUS CARDIOVERTER-DEFIBRILLATOR SYSTEMS

Subclavian crush syndrome, described with pacemaker leads implanted vi a subclavian puncture, may occur when conductor fractures and insulati on breaches develop by compression of a lead between the first rib and clavicle. We reviewed our experience in 164 patients who underwent in tended implantation of transvenous defibrillator systems to determine the clinical relevance of subclavian crush syndrome in defibrillator p atients. Venous access was obtained via subclavian puncture in 114 pat ients (70%) and via cephalic cut-down in 50 patients (30%). Nonthoraco tomy lead systems, with or without subcutaneous patch, were successful ly implanted in 131 of 164 patients (79.9%). Thoracotomy was required in 32 patients (19.5%) and subxiphoid patch in 1 patient (0.6%). Over a mean of 12.9 months (range 1-62 months), 3 patients (1.8%) required revision of the rate sensing lead/coil or superior vena caria coil aft er development of lead compression fractures in the region of the clav icle and first rib. In all 3 patients the leads had been implanted via subclavian puncture (2.6% of patients in whom the subclavian techniqu e was utilized). Two patients presented with spurious shocks. One pati ent was asymptomatic. Conclusions: When venous access is obtained via subclavian puncture, subclavian crush syndrome may develop in patients with transvenous defibrillator systems. Patients may be asymptomatic and lead fractures may go unrecognized. When implanting transvenous de fibrillator systems? strong consideration should be given to obtaining venous access primarily via the cephalic cut-down technique.