Clinical predictors of successful cephalic vein access for implantation of endocardial leads.

BACKGROUND: The purpose of this study was to determine whether there are any patient characteristics that predict successful use of the cephalic vein for endocardial lead implantation.
METHODS: One-hundred fifty consecutive patients who underwent implantation of one or more endocardial pacemaker (N = 63) or defibrillator (N = 87) leads using a cephalic vein approach were included in this prospective study. The mean age of the patients was 63 +/- 14 years, and 115 (77%) were men. Ninety-one patients (61%) had coronary artery disease, 77 patients (51%) had hypertension, and 42 patients (28%) had diabetes. The mean ejection fraction was 0.34 +/- 0.17.
RESULTS: At least one lead was successfully implanted using a cephalic vein approach in 96 patients (64%). The most common reason for failure of the cephalic vein approach was a small cephalic vein, found in 25 patients (17%). Independent predictors of successful cephalic vein use were diabetes (p < 0.001), ejection fraction < or = 0.40 (p < 0.05), and male gender (p < 0.05). At least one endocardial lead was implanted in 19 of the 24 (79%) men who had an ejection fraction < or = 0.40 and diabetes, compared to 4 of the 11 (36%) women who had an ejection fraction > 0.40 and did not have diabetes. The only independent predictor of successful cephalic vein implantation among nondiabetics was an ejection fraction < or = 0.40 (p < 0.01). Body size was not an independent predictor of successful cephalic vein use.
CONCLUSION: Baseline patient characteristics influence the likelihood of successful endocardial lead implantation using a cephalic vein approach. Diabetes, ventricular dysfunction, male gender and are associated with an increased likelihood of a successful implant using the cephalic vein. Smaller leads and and better techniques are needed to improve the success rate of cephalic vein implantation in all patients.