Abstract: Aim: was to evaluate the importance of pre-procedural cephalic vein (CV) angiography for pacemaker (PM) implantation better results. Methods: 94 patients (pts) (55 women) aged 23-93 years old were included into the study Pts were randomized into two groups (1:1). Group I (n=47; 24 females): angiography of CV was made before PM implantation. In Group II PM implantation was performed without previously angiography Endpoints: time of procedure, efficacy doses Results: fluoroscopy time and length of procedure in group I were less than in group II (p=0.0002 and p<0.0001 respectively). Four types of CV anatomy were found. Thus, I type of CV anatomy was most favorable for procedure due to angle between v.cephalica and subclavian vein less then 900. Conclusion: the acute angle of cephalic-axillary confluence is the most common type of CV anatomy and is associated with most success of procedure. Implantation of PM taking into consideration variants of anatomical structure of v cephalica in the subclavian area can reduce the radiation dose, possibility of complications, as well as reduce the duration of the intervention. Preoperative evaluation of the anatomical structure of veins of upper limbs before implantation of permanent pacemakers is a rational approach that allows choosing the method of conducting endocardial electrodes in the right heart. References 1. Raatikainen M.J., Arnar D.O., Zeppenfeld K., et al. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace. 2015 Jan; 17, i1-i75. 2. Hindricks G., Camm J., Merkely B., et al. The current status of cardiac electrophysiology in ESC members countries. The EHRA White Book 2016. 3. Hindricks G., Camm J., Merkely B., et al. The current status of cardiac electrophysiology in ESC members countries. The EHRA White Book 2017. 4. Poole J., Gleva M., Mela T., et al. Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry. Circulation. 2010 Oct 19; 122 (16): 1553-1561. 5. Bongiorni M., Proclemer A., Dobreanu D., et al. Preferred tools and techniques for implantation of cardiac electronic devices in 6. Furman S. Venous cutdown for pacemaker implantation. Ann Thorac Surg. 1986 Apr; 41 (4): 438-439. 7. Parsonnet V., Bernstein A., Lindsay B., et al. Pacemaker-implantation complication rates: an analysis of some contributing factors. J Am Coll Cardiol. 1989 Mar 15; 13 (4): 917-921. 8. Atlas sravnitelnoy rentgenohirurgicheskoy anatomii. [Atlas of comparative radiosurgical anatomy] Pod red. L.S. Kokova. M.: Radiologiya-Press. 2012; 388 s [ In Russ]. 9. Bokeriya L.A., Revishvili A.Sh., Golitsyn S.P., Egorov D.F., Popov S.V., Sulimov V.A., et all. Klinicheskiye rekomendatsii po provedeniyu elektrofiziologicheskikh issledovaniy. kateternoy ablyatsii i primeneniyu implantiruyemykh antiaritmicheskikh ustroystv. Vserossiyskoye nauchnoye obshchestvo spetsialistov po klinicheskoy elektrofiziologii. Aritmologii i kardiostimulyatsii (VNOA). [Clinical recommendations for conducting electrophysiological studies, catheter ablation and the use of implantable antiarrhythmic devices. All-Russian scientific society of specialists in clinical electrophysiology, arrhythmology and pacemaking (VNOA)] 2013; 15 s [ In Russ]. 10. Magney J., Flynn D., Parsons J., et al. Anatomical mechanisms explaining damage to pacemaker leads, defibrillator leads, and failure of central venous catheters adjacent to the sternoclavicular joint. Pacing Clin Electrophysiol. 1993 Mar;16 ( 11. Chan N., Kwong N., Cheong A., et al. Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown. Europace (2016), euw147. 12. Shima H., Ohno K., Shimizu T., et al. Anatomical study of the valves of the superficial veins of the forearm. J Craniomaxillofac Sur 1992; 20: 305-309. 13. Tse H., Lau C., Leung S., et al. A cephalic vein cutdown and venography technique to facilitate pacemaker and defibrillator lead implantation. Pacing Clin Electrophysiol. 2001 Apr; 24 ( 14. Knight B., Curlett K., Oral H., et al. Clinical predictors of successful cephalic vein access for implantation of endocardial leads. J Interv Card Electrophysiol. 2002 Oct; 6 (2): 177-180.
