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Background: When permanent cardiac stimulation device implantation via superior venous access (i.e., cephalic, axillary or subclavian veins) is not possible or advisable, safe and feasible surgical alternatives must be used. The transfemoral approach is relatively unknown; therefore, it is seldom used and studied. This single-centre study analysed the 20-year outcomes of patients who underwent implantation using a transfemoral implantation approach.

Methods: Data on the implantation procedure (indication, approach, lead and pacemaker models, complications), patient characteristics (age, sex, medications, comorbidities), and follow-up were analysed for all patients who underwent permanent cardiac stimulation device implantation using the transfemoral approach between June 2001 and December 2021.

Results: A permanent cardiac stimulation device was implanted using the transfemoral approach in 66 patients (mean age, 76 years [range: 45-96], 40 [60%] men). The most frequent indication was atrioventricular block, associated with sinus rhythm in 36 patients and atrial fibrillation in 11 patients. The mean implantation time was 61 min (range: 20-210), and the mean fluoroscopy time was 7.9 min (range: 0.2-87). The minimum follow-up period was one year (December 2022), with a mean of 60 months [range: 2-180]). Overall, 26 patients (42%) were treated with oral anticoagulants postimplantation. No deaths, septic episodes, or severe complications were associated with the procedure in the short or long term. Follow-up data were available for 64 patients, of whom 52 (81%) died during follow-up (mean age, 84 years [range: 55-101]). No deaths were associated with the use of the transfemoral technique.

Conclusions: Permanent cardiac stimulation device implantation using the transfemoral access approach is feasible and straightforward for an experienced implant surgeon. The outcomes of systems implanted by the transfemoral access approach were comparable to those of systems implanted by the superior venous approach, and no severe complications were observed at the 20-year follow-up.