51
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Chia HM, Anderson D, Jackson G. Pacemaker-induced superior vena cava obstruction: bypass using the intact azygous vein. Pacing Clin Electrophysiol 1999; 22:536-7. [PMID: 10192867 DOI: 10.1111/j.1540-8159.1999.tb00486.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Superior vena cava thrombosis due to pacemaker leads is an uncommon but well-recognized complication. Its pathogenesis remains unclear and it is usually a benign condition. Superior vena cava occlusion can be successfully treated by thrombolysis and anticoagulation if the occlusion is recent, balloon venoplasty and stenting, and surgery. We describe a case of superior vena cava obstruction successfully bypassed using the intact native azygous vein, a technique that has not been described before, with excellent long-term results.
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Affiliation(s)
- H M Chia
- Cardiothoracic Centre, St. Thomas' Hospital, (Guy's & St. Thomas Hospital Trust), London
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52
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Ing FF, Mullins CE, Grifka RG, Nihill MR, Fenrich AL, Collins EL, Friedman RA. Stent dilation of superior vena cava and innominate vein obstructions permits transvenous pacing lead implantation. Pacing Clin Electrophysiol 1998; 21:1517-30. [PMID: 9725149 DOI: 10.1111/j.1540-8159.1998.tb00238.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to assess the feasibility of stent dilation of venous obstructions/occlusions to permit transvenous pacing lead implantation. Innominate vein or superior vena cava (SVG) obstruction may preclude the implantation of transvenous pacing leads. Patients with d-transposition of the great arteries, after a Mustard or Senning procedure, and children with previously placed transvenous pacing leads are at higher risk for this vascular complication. From May 1993 to January 1996, eight pediatric patients who underwent transvenous pacing lead implantation or replacement were found to have significant innominate vein or SVC obstruction or occlusion. Utilizing intravascular stents, a combined interventional and electrophysiological approach was used to relieve the venous obstruction and to permit implantation of a new transvenous pacing lead. Two patients had complete SVC occlusion requiring puncture through the obstruction with a transseptal needle. Vessel recanalization was achieved with balloon dilation and stent implantation. The remaining six patients had severe venous obstruction with a mean minimum diameter of 3.1 +/- 3.3 mm. The mean pressure gradient across the obstructed veins was 8.6 +/- 7.3 mmHg. Following implantation of 15 Palmaz P308 stents in eight vessels, the mean diameter increased to 14.2 +/- 1.9 mm and the mean pressure gradient across the stented vessels decreased to 1.0 +/- 2.0 mmHg. A transvenous pacing lead was implanted successfully through the stent(s) immediately or 6-8 weeks later. Innominate vein and SVC obstruction can be safely and effectively relieved with intravascular stents and permit immediate or subsequent transvenous pacing lead implantation.
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Affiliation(s)
- F F Ing
- Department of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, USA
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53
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Çeliker C, Sayman H, Ersanli M, Hamidi M, Doğruca Z, Yazicoğlu N. Diagnosis of Abnormal Subclavian Venous Flow by Radionuclide Venography in Patients with Permanent Pacemaker. Int J Angiol 1998; 7:265-7. [PMID: 9585466 DOI: 10.1007/bf01617409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In this study, we investigated the role of radionuclide venography in the diagnosis of abnormal subclavian venous flow due to the lead in patients (pts) with permanent pacemakers. The study was conducted with 53 frames in 52 asymptomatic pts (26 females, mean age 64.5 +/- 15; range 25-89 years). The mean time after implant was 67.6 +/- 47.5 months. Technetium 99m pertecnetate (250 MBq) was given to both antecubital veins simultaneously. The images were acquired in 0.25-second frames for 20 seconds. The pts were evaluated visually in terms of the activity flow through the subclavian veins bilaterally. The retrograde flow in the jugular vein, decrease in flow rate, and subtotal and total obstruction of the subclavian veins were accepted as abnormal venous flow patterns. In 17 pts with abnormal findings, 10 (58.8%) had retrograde flow in the jugular vein, 4 had (23.5%) decreased flow rate, 1 (5.8%) had subtotal and 2 (11.7%) total obstruction in the subclavian vein. The mean of the body diameter of the leads was significantly greater and the percentage of the silicone-insulated leads was higher (76% vs 52%) in the group with abnormal flow. No complication due to the procedure was seen. In conclusion, radionuclide venography, a noninvasive method, may be used easily and safely to show the venous flow abnormalities due to the lead in pts with permanent pacemakers. The abnormal subclavian venous flow was especially seen in pts who had larger leads.
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Affiliation(s)
- C Çeliker
- The Institute of Cardiology, University of Istanbul, Istanbul, Turkey
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54
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De Cock C, Stooker W, Visser CA. Unusual approach of a pacemaker electrode in a patient with a silent superior vena cava syndrome. Pacing Clin Electrophysiol 1998; 21:1167-9. [PMID: 9604254 DOI: 10.1111/j.1540-8159.1998.tb00168.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A man with a history of bilateral pectoral pocket infection and subsequent pacemaker implantation with a screw-in epicardial lead was referred because of increasing lead impedance. Venography revealed bilateral total occlusion of the subclavian and innominate veins with extensive collateral formation in this asymptomatic patient. Both internal jugular veins were also totally occluded. Because repeated pacemaker implantation using epicardial leads resulted in increasing lead impedance of the ventricular lead within 1 year after implant, an alternative approach was found using the superior caval vein with minimal invasive thoracotomy for single lead VDD pacing.
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Affiliation(s)
- C De Cock
- Department of Cardiology, Academic Hospital VU, Amsterdam, The Netherlands. cardiol@ azvu.nl
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55
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Karpawich PP, Stokes KB, Proctor K, Schallhorn R, McVenes R. "In-line" bipolar, steroid-eluting, high impedance, epimyocardial pacing lead. Pacing Clin Electrophysiol 1998; 21:503-8. [PMID: 9558680 DOI: 10.1111/j.1540-8159.1998.tb00091.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recent advances in electrode surface designs have eliminated traditional threshold differences between endo- and epicardial pacing leads. Since the epicardial approach offers the potential of direct left ventricular pacing and the transvenous approach may not be feasible or warranted in all instances, more advanced leads are being designed to optimize epicardial pacing capabilities. This study was conducted to evaluate a bipolar epimyocardial lead. Six immature canines (age 3 months) were instrumented. The lead (Medtronic model 10389) is a single-pass, "in-line" bipolar electrode with low current drain and high impedance, with an intramyocardial steroid-eluting cathode and nonsteroid epicardial anode. Twelve ventricular leads were implanted (two per animal) and the animals followed for 6 months with weekly analysis of pacing and sensing capabilities. Results at explant were compared with implant values and showed no significant differences between sensed R waves or in R wave slew rates in unipolar or bipolar modes. Explant lead impedances remained high in both modes: bipolar, 1658 +/- 331; and unipolar, 1327 +/- 308 omega (P < 0.05). Chronic voltage (V) threshold at 0.5 ms showed no significant change from implant values during the study: unipolar, 0.3 +/- 0.06 versus 1.0 +/- 0.8; and bipolar, 0.4 +/- 0.06 versus 1.6 +/- 1.2. Histologic review showed negligible fibrous reaction at the electrode-tissue interface. This study introduces a high impedance, low threshold, "in-line" bipolar pacing lead design capable of stable chronic pacing with implant facilitated by a single suture technique.
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Affiliation(s)
- P P Karpawich
- Section of Cardiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201, USA
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56
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Pace JN, Maquilan M, Hessen SE, Khoury PA, Wilson A, Kutalek SP. Extraction and replacement of permanent pacemaker leads through occluded vessels: use of extraction sheaths as conduits--balloon venoplasty as an adjunct. J Interv Card Electrophysiol 1997; 1:271-9. [PMID: 9869980 DOI: 10.1023/a:1009724908464] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients (pts) may present for lead extraction with symptomatic or asymptomatic subclavian vein or superior vena cava thrombosis. Replacement of permanent pacemaker leads (PPLs) in these pts may be difficult and may require accessing a new site. We examined the utility of replacing PPLs through completely occluded vessels using extraction sheaths as conduits through the total occlusion. Over six years, a total of 210 atrial and/or ventricular PPLs were extracted from 137 pts. Two pts presented with angiographically documented thrombotic occlusion of the subclavian vein. One additional pt. who had presented with a superior vena cava (SVC) syndrome, had a totally occluded innominate vein and SVC occlusion. Balloon venoplasty was used as an adjunct to dilate the SVC. In all pts, after PPLs were removed via a subclavian extraction sheath through the occluded vessel, the retained sheath was used to place a guide wire, then a peel away dilating sheath, to insert new PPLs, in each case on the side of total venous occlusion. Seven PPLs and two lead fragments were extracted, and five new PPLs replaced, ipsilateral to the venous occlusion. These data show that extraction of PPLs through thrombosed veins may be performed successfully and may not require replacing the leads through a new site. This technique spares the pt the need to access the opposite subclavian vein, and it avoids an excessive number of PPLs in the subclavian vein and SVC. The procedure illustrates an efficient means to reintroduce new PPLs with the potential to reduce associated morbidity, since repeat puncture of the subclavian vein is not required. Safety of the procedure as a whole must be considered with regard to the known risks of lead extraction, some complications of which may be substantial using current techniques.
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Affiliation(s)
- J N Pace
- Cardiac Electrophysiology Laboratory of MCP-Hahnemann School of Medicine, Allegheny University Hospitals, Hahnemann Division, Philadelphia, PA, USA
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57
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Figa FH, McCrindle BW, Bigras JL, Hamilton RM, Gow RM. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol 1997; 20:1902-9. [PMID: 9272526 DOI: 10.1111/j.1540-8159.1997.tb03594.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To determine the incidence and risk factors for venous obstruction in children with transvenous pacing leads, 63 children were evaluated clinically and echocardiographically. Patients with abnormal clinical and/or echocardiographic findings were further investigated by venography. Thirteen patients (21%) had evidence of venous obstruction. Venography in 11 (2 refused) showed that severity of obstruction (as defined by percentage of luminal narrowing) was complete (100%) in 3, severe (> 90%) in 4, and moderate (60%-90%) in 5 (1 patient having 2 sites of obstruction). Risk factors for obstruction in 55 patients with single implantation procedures (10 with obstruction; 18%) were sought. Total cross-sectional area of lead(s) was indexed to body surface area at implantation (INDEX). Patients with obstruction had a higher mean INDEX (7.6 +/- 1.6 mm2/m2) than patients without obstruction (4.9 +/- 2.0 mm2/m2); P < 0.0002). Receiver-operator characteristic curves showed an INDEX > 6.6 mm2/m2 to best predict obstruction, with a sensitivity of 90% and specificity of 84%. Since pacing is lifelong, sizing of transvenous leads to the child is important to prevent obstruction and preserve venous access.
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Affiliation(s)
- F H Figa
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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58
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Abstract
A woman with persistent pacemaker induced superior vena cava syndrome was stable for 10 years. Serial follow-up venography, however, demonstrated a continuous process of major vein occlusion and the development of collateral circulation, the effectiveness of which warrants a favorable prognosis in this pacemaker related syndrome.
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Affiliation(s)
- H Kataoka
- Department of Internal Medicine, Nishida Hospital, Oita, Japan
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59
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Roguin A, Edelstein S, Edoute Y. Superior vena cava syndrome as a primary manifestation of Behçet's disease. A case report. Angiology 1997; 48:365-8. [PMID: 9112886 DOI: 10.1177/000331979704800411] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Superficial thrombophlebitis is a common finding in Behçet's disease. However, the potential life-threatening complication of superior vena cava (SVC) syndrome due to thrombotic occlusion is a rare manifestation and usually occurs several years after the onset of the diagnosis. The authors describe a twenty-nine-year-old Arab man who had an acute thrombosis of the SVC as the presenting manifestation of his Behçet's disease. The patient was successfully treated with thrombolytic and anticoagulant therapy, and during follow-up no relapse was observed. Behçet's disease should be suspected in young patients presenting with thrombosis of the SVC and without evidence of a hypercoagulable state.
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Affiliation(s)
- A Roguin
- Internal Medicine C Department, Rambam Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
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60
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Nishino M, Tanouchi J, Ito T, Tanaka K, Aoyama T, Kitamura M, Nakagawa T, Kato J, Yamada Y. Echographic detection of latent severe thrombotic stenosis of the superior vena cava and innominate vein in patients with a pacemaker: integrated diagnosis using sonography, pulse Doppler, and color flow. Pacing Clin Electrophysiol 1997; 20:946-52. [PMID: 9127400 DOI: 10.1111/j.1540-8159.1997.tb05498.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thrombosis of the innominate vein and SVC is a serious complication in patients with pacemakers, inducing pulmonary embolism or SVC syndrome. Venography is the definitive method for its diagnosis; however, it is too invasive for related studies. The purpose of this study was to validate sonography, pulse Doppler, and color flow in detecting noninvasively innominate vein or SVC thrombosis in patients with pacemakers. In 53 patients with pacemakers, the 1 severe SVC stenosis and 18 severe innominate vein stenoses due to thrombosis were diagnosed by digital subtraction angiography. Sonography accurately showed the severe SVC stenosis due to thrombosis, but had limitations on the innominate vein thrombosis. Color flow demonstrated mosaic flow, indicating poststenotic turbulence due to stenosis of the innominate vein and SVC caused by thrombosis in 15 of 16 patients, and pulse Doppler disclosed absence of flow due to complete occlusion of the innominate vein in 2 of 2 patients. Sensitivity and specificity for detecting severe innominate vein stenosis due to thrombosis using combined color flow and pulse Doppler was 94% and 100%, respectively. In conclusion, sonography, pulse Doppler, and color flow allow accurate detection of severe innominate vein or SVC stenosis due to thrombosis, and are therefore useful for the follow-up of patients with a pacemaker.
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Affiliation(s)
- M Nishino
- Division of Cardiology, Osaka Rosai Hospital, Japan
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61
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Affiliation(s)
- Z Wahbi
- Department of Cardiology, Pinderfields Hospital NHS Trust, Wakefield, UK
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62
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Kastner RJ, Fisher WG, Blacky AR, Bacon ME. Pacemaker-induced superior vena cava syndrome with successful treatment by balloon venoplasty. Am J Cardiol 1996; 77:789-90. [PMID: 8651139 DOI: 10.1016/s0002-9149(97)89222-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This is a case report of pacemaker-induced superior vena cava syndrome in which the patient was successfully treated with balloon venoplasty. Six-month follow-up demonstrates angiographic patency and resolution of symptoms.
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Affiliation(s)
- R J Kastner
- National Naval Medical Center, Division of Cardiovascular Diseases, Bethesda, Maryland 20889-5600, USA
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63
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Marzo KP, Schwartz R, Glanz S. Early restenosis following percutaneous transluminal balloon angioplasty for the treatment of the superior vena caval syndrome due to pacemaker-induced stenosis. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 36:128-31. [PMID: 8829833 DOI: 10.1002/ccd.1810360208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Superior vena caval syndrome (SVC) following transvenous pacemaker insertion is an uncommon complication that has been treated with percutaneous transluminal balloon angioplasty. We report a case of SVC syndrome following pacemaker implantation that was treated with angioplasty. Several days after the initial balloon dilation, the patient had recurrent symptoms and evidence of restenosis on catheterization. Following repeat balloon dilation of this restenotic lesion, the patient had a favorable clinical response evidenced on hemodynamic and angiographic follow-up at 6 months.
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Affiliation(s)
- K P Marzo
- Department of Cardiology, Winthrop-University Hospital, Mineola, New York 11501, USA
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64
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Abstract
We report a unique case of Budd-Chiari syndrome caused by pacemaker leads-induced thrombosis. A 34 year old female patient was subjected to a permanent pacemaker insertion because of refractory paroxysmal supraventricular tachycardia attacks related to Wolff-Parkinson-White syndrome. Three years later, another pacemaker was re-implanted because of its dislodgement. Four episodes of skin infections at the implantation site were noted thereafter. The patient developed symptoms of abdominal pain and ascites 5 years after the second pacemaker implantation. Ultrasonography and computerized tomography of the abdomen revealed hepatomegaly with ascites and dilated inferior vena cava. An echocardiogram displayed thrombus formation in the superior vena cava, the right atrium and the inlet of the inferior vena cava into the right atrium. Inferior and superior venacavogram confirmed the above findings. With the impression that Budd-Chiari syndrome was caused by pacemaker-induced thrombus, we removed the pacemaker first and thoracotomy with thrombectomy was then performed. The clinical symptoms resolved after the operation. To our knowledge, this is the first case reported in the literature and this observation supported the thrombosis theory for membranous obstruction of inferior vena cava.
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Affiliation(s)
- C L Lu
- Department of Medicine, Veterans General Hospital Taipei, Taiwan, ROC
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65
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Odell JA, Keeton GR, Millar RN, Beningfield SJ. Pacemaker induced superior vena cava obstruction: management by spiral vein graft. Pacing Clin Electrophysiol 1995; 18:739-42. [PMID: 7596860 DOI: 10.1111/j.1540-8159.1995.tb04672.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 35-year-old male developed superior vena cava (SVC) obstruction due to multiple retained pacemaker leads. This caused cyanosis and suffusion of the head and neck during arm exercise, with desaturation from 99%-90% demonstrated by ear oximetry. The SVC was bypassed using a spiral vein graft because of worsening symptoms. Dramatic improvement resulted, with desaturation no longer demonstrable.
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Affiliation(s)
- J A Odell
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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66
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Francis CM, Starkey IR, Errington ML, Gillespie IN. Venous stenting as treatment for pacemaker-induced superior vena cava syndrome. Am Heart J 1995; 129:836-7. [PMID: 7900642 DOI: 10.1016/0002-8703(95)90341-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- C M Francis
- Department of Cardiology, Western General Hospital, Edinburg, Scotland, UK
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67
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Hoyer MH, Beerman LB, Ettedgui JA, Park SC, del Nido PJ, Siewers RD. Transatrial lead placement for endocardial pacing in children. Ann Thorac Surg 1994; 58:97-101; discussion 101-2. [PMID: 8037568 DOI: 10.1016/0003-4975(94)91078-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transvenous placement of endocardial leads in children may be difficult due to restrictions and complications of vascular access. We have placed endocardial leads from a transatrial approach in 5 children with various cardiac malformations. The usual surgical approach involved an anterolateral thoracotomy and, under fluoroscopic guidance, passage of the lead tip directly through the right atrial wall and across the tricuspid valve to the apex of the right ventricle. At a mean follow-up time of 23.2 months (range, 12.0 to 27.9 months), all patients have low thresholds for myocardial capture, and there have been no complications. We conclude that placement of endocardial leads by a transatrial approach provides an excellent alternative to an epicardial system in children destined for lifelong pacing.
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Affiliation(s)
- M H Hoyer
- Division of Pediatric Cardiology, Children's Hospital, Pittsburgh, Pennsylvania
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68
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Lindsay HS, Chennells PM, Perrins EJ. Successful treatment by balloon venoplasty and stent insertion of obstruction of the superior vena cava by an endocardial pacemaker lead. Heart 1994; 71:363-5. [PMID: 8198887 PMCID: PMC483687 DOI: 10.1136/hrt.71.4.363] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 63 year old man with symptomatic obstruction of the superior vena cava associated with an indwelling pacemaker was successfully treated with balloon venoplasty and stent insertion. He was symptom free with normal pacemaker function nine months later.
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Affiliation(s)
- H S Lindsay
- Department of Cardiology, Leeds General Infirmary
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69
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Cox JN. Pathology of cardiac pacemakers and central catheters. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1994; 86:199-271. [PMID: 8162711 DOI: 10.1007/978-3-642-76846-0_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J N Cox
- Department of Pathology, CMU, Geneva, Switzerland
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70
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Nagatomo Y, Nakagawa S. Superior vena cava obstruction caused by fibrosis or thrombosis in patients with implanted transvenous pacemakers. Pacing Clin Electrophysiol 1993; 16:1080-1. [PMID: 7685889 DOI: 10.1111/j.1540-8159.1993.tb04584.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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71
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Mazzetti H, Dussaut A, Tentori C, Dussaut E, Lazzari JO. Superior vena cava occlusion and/or syndrome related to pacemaker leads. Am Heart J 1993; 125:831-7. [PMID: 8438712 DOI: 10.1016/0002-8703(93)90178-c] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Four cases of pacemaker-related SVC obstruction or syndrome are reported. While two of them lacked any symptom suggestive of SVC obstruction, the other two presented with mild symptoms. None of them received any treatment. One died from a cause unrelated to SVC obstruction, while the others presented no change in their clinical status. A review of the literature suggests that neither thrombotic nor fibrotic obstruction in patients with pacemaker leads is strictly related to the number of abandoned leads, the presence of severed leads, or the time elapsing from pacemaker implant. The diagnosis is clinically made and is confirmed by venography. Only one of the reported deaths is attributable to SVC obstruction. The remaining cases from the literature responded to treatment with heparin, thrombolytic agents, angioplasty, or surgery.
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Affiliation(s)
- H Mazzetti
- Cardiology Division, Pirovano Hosptial, Buenos Aires, Argentina
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72
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Nagatomo Y, Fukunaga T, Koiwaya Y, Eto T. Pacing failure due to increased stimulation threshold 2 years after transvenous permanent pacemaker implantation. Pacing Clin Electrophysiol 1993; 16:125. [PMID: 7681165 DOI: 10.1111/j.1540-8159.1993.tb01543.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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73
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Karpawich PP, Hakimi M, Arciniegas E, Cavitt DL. Improved chronic epicardial pacing in children: steroid contribution to porous platinized electrodes. Pacing Clin Electrophysiol 1992; 15:1151-7. [PMID: 1381083 DOI: 10.1111/j.1540-8159.1992.tb03118.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Although new "low threshold" epicardial electrodes combine steroid with a porous, platinized-platinum surface, the actual contribution of steroid elution has not been established. We evaluated this new electrode surface design with and without steroid in 13 children, ages 1-22 years. Both electrodes are unipolar and of similar surface area. The Medtronic Model 4951-P is a barb design for epimyocardial insertion without steroid while the Model 10295A is a steroid eluting, epicardial disk-shaped design. Both electrodes were implanted for atrial and ventricular pacing. At implant, sensed P and R waves, and pacing impedances were comparable between both electrodes. There were no significant differences between initial measured pulse width or calculated energy thresholds for the first 2 months following implant. Strength-duration curves for both electrodes at 1 month were comparable to implant values. After 2 months, the threshold of the nonsteroid electrode peaked and stabilized at a significantly higher (P less than 0.05) level than the more constant steroid eluting electrode. This difference continued for the first year following implant. We conclude that the new porous, platinized-platinum electrode design intrinsically limits initial electrode-tissue interface reactivity in children and improves epicardial pacing with low chronic threshold values. Steroid elution augments these intrinsic qualities by maintaining fibrous capsule stability with more constant low thresholds over time.
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Affiliation(s)
- P P Karpawich
- Section of Cardiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201
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74
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Abstract
We reviewed the incidence, clinical features, current diagnostic evaluations, and treatments of venous complications that can occur after implantation of a transvenous pacemaker. Of the approximately 80 published articles on the potential venous complications after implantation of a permanent transvenous pacemaker, we selected 63 that addressed the clinical features, diagnosis, and treatment of pacemaker lead-induced venous thrombosis, which occurs in approximately 30 to 45% of patients early or late after implantation of a transvenous pacemaker. Most patients with chronic deep venous thrombosis remain asymptomatic because of the development of an adequate venous collateral circulation. Clinical features of pacemaker lead-induced deep venous thrombosis, although rare, are easily recognized. They should be sought routinely during follow-up of all patients with transvenous pacemaker leads because venous obstruction can interfere with intravenously administered therapy, monitoring of central venous pressure, and revision of a pacemaker lead. Acute deep venous thrombosis is likely to be symptomatic. Early recognition and treatment of acute deep venous thrombosis may help to decrease the potential morbidity and mortality. The definitive diagnosis of pacemaker lead-induced venous thrombosis necessitates contrast-enhanced or digital subtraction venography. Management includes anticoagulation, thrombolytic therapy, surgical intervention, and, recently, percutaneous transluminal balloon venoplasty and depends on the duration, extent, and site of venous occlusion as well as the accompanying symptoms.
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Affiliation(s)
- P C Spittell
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905
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Parry G, Goudevenos J, Jameson S, Adams PC, Gold RG. Complications associated with retained pacemaker leads. Pacing Clin Electrophysiol 1991; 14:1251-7. [PMID: 1719502 DOI: 10.1111/j.1540-8159.1991.tb02864.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Retention of functionless pacemaker leads may occur following mechanical or infective problems (potentially or definitely infected) or after electrical failure of the lead. One hundred nineteen patients with a pacemaker lead (or leads) retained between 1970 and 1990 were reviewed retrospectively. Lead retention after an intervention dictated by potential or definite infection of the pacing system resulted in complications in 27 of 53 patients (51%), which in 22 patients (42%) were major (septicemia, superior vena cava syndrome, and further surgery under general anesthesia for recurrent "infective" problems) including three deaths. Complications were less likely if lead retention occurred after electrical failure with three minor and two major (surgery under general anesthesia, superior vena cava syndrome) complications in 66 patients (P less than 0.001). Bacteriology of swabs taken at the time of retention in the patients with potential or definite infection was unhelpful in predicting future complications: 8/18 patients (44%) whose swabs were negative had complications of which 5/18 (28%) were major. In our experience retention of functionless pacemaker leads after an intervention dictated by potential or definite infection of the pacing system, is associated with significant morbidity and mortality and should be avoided.
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Affiliation(s)
- G Parry
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Abstract
A 53 year old woman with symptomatic pacemaker associated superior vena cava syndrome was treated successfully with balloon angioplasty. She was well six months after the procedure.
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Affiliation(s)
- A A Grace
- Cardiac Unit, Papworth Hospital, Cambridge
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