Safety of Venography-Guided Extrathoracic Vein Puncture to Prevent Pneumothorax in Pacemaker Implantation

INTRODUCTION: Pacemaker implantation is routinely and widely used around the world for a variety of heart conditions. The use of venography guidance is very important for the operator at the puncture site and prevent complications such as pneumothorax. The aim of this study is to determine the effect of venography in preventing complications and to compare the rate of pneumothorax between patients operated with and without venography guidance.
METHODS: A total of 539 consecutive patients who had a pacemaker implanted in our clinic between 2012 and 2022 were included in this study. Pacemaker type according to the number of leads used, diagnosis for pacemaker implantation, patient age, gender, concomitant chronic obstructive pulmonary disease (COPD), presence of defibrillator battery and lead, venography guidance were evaluated and their contribution to the complication of pneumothorax was analyzed.
RESULTS: The incidence of pneumothorax development was found to be 1.3% in our study. Venography guidance was found to be significantly protective against pneumothorax, as the patient group that developed pneumothorax consisted of patients who did not undergo venography at a high rate. It was determined that in the patient group that developed pneumothorax, there was a high percentage of patients between the ages of 18-65, of female gender, without concomitant COPD, with 2 leads inserted and with implantable cardioverter defibrillator (ICD) implantation (single/double leads). Our study revealed that routine venography in pacemaker implantation is an effective method to protect patients from pneumothorax as well as lead fracture.
DISCUSSION AND CONCLUSION: Our study revealed that routine venography during pacemaker implantation is an effective method to protect patients from pneumothorax. Since blind puncture of venous structures increases the risk of complications, venography guidance can be used routinely in pacemaker implantation.