Long-term outcomes of low anterior axillary implantation for cardiac implantable electronic devices in patients with limited pectoral access: A single-center experience
Heart Rhythm O2, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.hroo.2026.07.015
- Dergi Adı: Heart Rhythm O2
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus
- Anahtar Kelimeler: Cardiac device infection, Cardiac implantable electronic device, Defibrillation threshold, Device reimplantation, Low axillary approach
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background Reimplantation of cardiac implantable electronic devices (CIEDs) after system explantation or extraction for infection is particularly challenging in patients with limited bilateral pectoral access. Data regarding low anterior axillary implantation and its long-term outcomes remain limited. Objective To evaluate the feasibility, safety, defibrillation performance, and long-term outcomes of low anterior axillary CIED implantation in patients unsuitable for conventional pectoral reimplantation. Methods This study included 11 consecutive patients undergoing CIED reimplantation after prior device explantation or extraction for infection. All procedures were performed using a low anterior axillary approach with extrathoracic axillary venous access and posterior submuscular generator positioning. Implantable cardioverter-defibrillator (ICD) recipients underwent intraoperative defibrillation threshold testing. Procedural characteristics, electrical performance, and long-term clinical outcomes were retrospectively analyzed. Results Mean age was 57 ± 17 years, and 82% of patients were male. Implanted systems included single-chamber pacemakers (18%), dual-chamber pacemakers (27%), and ICDs (55%). Procedural success was achieved in all patients without acute major complications. All ICD recipients demonstrated successful defibrillation threshold testing with ventricular fibrillation termination using a 25-J shock and adequate safety margins. During a mean follow-up of 37 ± 26 months, 1 patient (9%) developed recurrent infection requiring system removal. No inappropriate shocks, lead-related complications, or device-related deaths occurred. Serial device interrogation demonstrated stable pacing, sensing, and impedance parameters throughout follow-up. Conclusion Low anterior axillary CIED implantation appears to be a feasible and effective alternative for selected patients with limited pectoral access after device infection, providing acceptable defibrillation performance, stable long-term electrical function, and favorable clinical outcomes.