Procedural and long-term outcomes of tunneled transvenous leads.

Background: Lead-related venous stenosis and occlusion can complicate the insertion or replacement of transvenous leads in patients with cardiac implantable electronic devices (CIEDs). A possible solution is to tunnel the lead from the contralateral vasculature to the ipsilateral generator. Procedural complications and long-term outcomes remain unclear with this technique.

Objective: We sought to assess outcomes of tunneled transvenous leads.

Methods: We retrospectively identified all patients who underwent transvenous CIED lead tunneling to a contralateral pocket at our institution between 2014 and 2024. Clinical characteristics, indications for lead implantation, postoperative complications, and long-term outcomes were collected.

Results: We identified that 27 patients underwent transvenous lead tunneling at our institution. Most patients were men (20, 74%) with a mean age of 68.8 ± 18.3 years. Most patients had nonischemic cardiomyopathy (16, 59%) with a mean ejection fraction of 29.3% ± 11.3%. The tunneled leads were coronary sinus leads (20, 74%), followed by defibrillator leads (5, 18.5%) and right ventricular pacing leads (2, 7.4%). Implantation procedures were primarily for device upgrade (18), lead revisions (8), or de novo lead placement (1). No postoperative complications were seen. Patients were followed for a mean of 2.2 ± 1.4 years. One tunneled defibrillator lead (3.7%) had low shock impedance 3 years after implantation, which was monitored and did not require an intervention.

Conclusion: In patients with ipsilateral venous occlusion, contralateral lead tunneling appears to be an effective and safe approach to manage patients with CIEDs and occluded ipsilateral subclavian veins.