Prevalence of central venous occlusion in patients with chronic defibrillator leads

Background Many patients with previously implanted ventricular defibrillato rs are candidates for an upgrade to a device capable of atrial-ventricular sequential or multisite pacing. The prevalence of venous occlusion after pl acement of transvenous defibrillator leads is unknown. The purpose of this study was to determine the prevalence of central venous occlusion in asympt omatic patients with chronic transvenous defibrillator leads. Methods Thirty consecutive patients with a transvenous defibrillator lead u nderwent bilateral contrast venography of the cephalic, axillary, subclavia n, and brachiocephalic veins as well as the superior vena cava before an el ective defibrillator battery replacement. The mean time between transvenous defibrillator lead implantation and venography was 45 +/- 21 months. Sixte en patients had more than 1 lead in the same subclavian vein. No patient ha d clinical signs of venous occlusion. Results One (3%) patient had a complete occlusion of the subclavian vein, 1 (3%) patient had a 90% subclavian vein stenosis, 2 (7%) patients had a 75% to 89% subclavian stenosis, 11 (37%) patients had a 50% to 74% subclavian stenosis, and 15 (50%) patients had no subclavian stenosis. Conclusions The low prevalence of subclavian vein occlusion or severe steno sis among defibrillator recipients found in this study suggests that the pl acement of additional transvenous leads in a patient who already has a vent ricular defibrillator is feasible in a high percentage of patients (93%).