Superior vena cava syndrome as a complication of DDD pacemaker implantation

Venous Obstruction in Cardiac Rhythm Device Therapy

PURPOSE OF REVIEW

A variety of complex vascular pathologies arise following the implantation of electronic cardiac devices. Pacemaker and defibrillator lead insertion may cause proximal venous obstruction, resulting in symptomatic venous congestion and the compromise of potential future access sites for cardiac rhythm lead management.

RECENT FINDINGS

Various innovative techniques to recanalize the vein and establish alternate venous access have been pioneered over the past few years. A collaborative team of electrophysiologists and vascular specialists strategically integrate the patient's vascular disease into the planning of electrophysiology procedures. When vascular complications occur after device implantation, the same team effectively manages both the resulting vascular sequelae and related cardiac rhythm device challenges. This review will outline the various vascular challenges related to device therapy and offer an effective strategy for their management.

Multiple Pacing Lead-Induced Superior Vena Cava Syndrome: Successful Treatment by Balloon Angioplasty

Pacemaker-induced SVC syndrome. The superior vena cava (SVC) syndrome is an uncommon but sometimes serious complication associated with permanently implanted pacemakers. The mechanical stress associated with pacemaker wires may lead to vessel wall inflammation, fibrosis, thrombus formation, and, ultimately, venous stenosis and occlusion. The surgical treatment of pacemaker-related SVC syndrome requires thoracotomy and may result in significant morbidity. The long-term effects on the pacemaker electrodes, due to compression between the stent and the wall of the vein, remain unknown. We describe a case in which balloon venoplasty successfully resolved the SVC syndrome. The patient has remained symptom-free and with normal pacemaker function for 6 months.

Morphological observation by intravascular ultrasound in superior vena cava syndrome after pacemaker implantation

We report a case of superior vena cava (SVC) syndrome that was assessed by intravascular ultrasound (IVUS). A highly echogenic eccentric lesion was demonstrated by IVUS. The use of IVUS also confirmed in vivo that SVC syndrome following pacemaker insertion occurs as a result of intimal thickening of the venous wall.

Superior vena cava occlusion and/or syndrome related to pacemaker leads

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.