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Franczyk B, Rysz J, Olszewski R, Gluba-Sagr A. Do Implantable Cardioverter-Defibrillators Prevent Sudden Cardiac Death in End-Stage Renal Disease Patients on Dialysis? J Clin Med 2024; 13:1176. [PMID: 38398488 PMCID: PMC10889557 DOI: 10.3390/jcm13041176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic kidney disease patients appear to be predisposed to heart rhythm disorders, including atrial fibrillation/atrial flutter, ventricular arrhythmias, and supraventricular tachycardias, which increase the risk of sudden cardiac death. The pathophysiological factors underlying arrhythmia and sudden cardiac death in patients with end-stage renal disease are unique and include timing and frequency of dialysis and dialysate composition, vulnerable myocardium, and acute proarrhythmic factors triggering asystole. The high incidence of sudden cardiac deaths suggests that this population could benefit from implantable cardioverter-defibrillator therapy. The introduction of implantable cardioverter-defibrillators significantly decreased the rate of all-cause mortality; however, the benefits of this therapy among patients with chronic kidney disease remain controversial since the studies provide conflicting results. Electrolyte imbalances in haemodialysis patients may result in ineffective shock therapy or the appearance of non-shockable underlying arrhythmic sudden cardiac death. Moreover, the implantation of such devices is associated with a risk of infections and central venous stenosis. Therefore, in the population of patients with heart failure and severe renal impairment, periprocedural risk and life expectancy must be considered when deciding on potential device implantation. Harmonised management of rhythm disorders and renal disease can potentially minimise risks and improve patients' outcomes and prognosis.
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Affiliation(s)
- Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Anna Gluba-Sagr
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
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Villegas EG, Torres JN, Domingo EJB, Dorrego MDP, del Rio JIJ, Valdiris UR, Carmona JCR, Fernandez IF, Peinado RP. Superior vena cava syndrome and pacemaker leads. Explant by mechanical dissection system of extraction and percutaneous recanalization with stents for new device implantation. HEART, VESSELS AND TRANSPLANTATION 2023. [DOI: 10.24969/hvt.2023.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Gabriels J, Chang D, Maytin M, Tadros T, John RM, Sobieszczyk P, Eisenhauer A, Epstein LM. Percutaneous management of superior vena cava syndrome in patients with cardiovascular implantable electronic devices. Heart Rhythm 2020; 18:392-398. [PMID: 33212249 DOI: 10.1016/j.hrthm.2020.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/26/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is no consensus regarding the optimal management of cardiovascular implantable electronic device (CIED)-related superior vena cava (SVC) syndrome. OBJECTIVE We report our experience with transvenous lead extractions (TLEs) in the setting of symptomatic CIED-related SVC syndrome. METHODS We reviewed all TLEs performed at a high-volume center over a 14-year period and identified patients in which TLE was performed for symptomatic SVC syndrome. Patient characteristics, extraction details, percutaneous management of SVC occlusions, and clinical follow up data were analyzed. RESULTS Over a 14-year period, more than 1600 TLEs were performed. Of these, 16 patients underwent TLE for symptomatic SVC syndrome. The mean age was 53.1 ± 12.8 years, and 9 (56.3%) were men. Thirty-seven leads, with a mean dwell time of 5.8 years (range 2-12 years), were extracted. After extraction, 6 patients (37.5%) received an SVC stent. Balloon angioplasty was performed before stenting in 5 cases (31.3%). There was 1 major complication (6.3%) due to an SVC tear that was managed surgically with a favorable outcome. Eleven patients underwent reimplantation of a CIED. Over a median follow-up of 5.5 years (interquartile range 2.0-8.5 years), 12 patients (75%) remained free of symptoms. CONCLUSION Combining TLE with the percutaneous treatment of symptomatic SVC syndrome is a safe and viable treatment strategy.
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Affiliation(s)
- James Gabriels
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
| | - David Chang
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Melanie Maytin
- Department of Electrophysiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas Tadros
- Department of Electrophysiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Roy M John
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Piotr Sobieszczyk
- Department of Interventional Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrew Eisenhauer
- Department of Cardiology, Central Maine Medical Center, Lewiston, Maine
| | - Laurence M Epstein
- Department of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York
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Wei S, Liu J, Li X, Song Z, Dong M, Zhao H, Zhao Q, Chen G, Chen J. A retrospective stenting study on superior vena cava syndrome caused by lung cancer. Thorac Cancer 2020; 11:1835-1839. [PMID: 32438532 PMCID: PMC7327698 DOI: 10.1111/1759-7714.13461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background Superior vena cava syndrome (SVCS) is a common condition predominantly caused by lung cancer. The presence of symptoms of SVCS, such as elevated intracranial pressure and laryngeal edema, indicates an unfavorable prognosis for lung cancer patients. Superior vena cava (SVC) stenting is the first‐line treatment for SVCS. In this study, we retrospectively analyzed SVCS cases treated with stenting in our center to explore the safety and effectiveness of stenting in the treatment of SVCS. Methods We reviewed 16 patients with SVCS caused by lung cancer who were treated at our center with endovascular stenting between 2016 and 2018. Patient information such as age, sex, type of lung cancer, obstruction condition, complications, survival time, and postoperative treatments are summarized. Results There were no treatment‐related complications in the perioperative period in any of the patients. Examination at postoperative day 2 indicated that the accompanying SVCS symptoms had improved in all patients. The median survival of patients treated along with combined postoperative chemotherapy and antivascular targeted therapy reached seven months (1–18 months). Conclusions SVC stenting is effective as a first‐line treatment modality for patients with SVCS caused by lung cancer. In combination with other treatment modalities, it can significantly alleviate symptoms and reduce complications, and thus it plays an important role in the treatment of patients with SVCS caused by lung cancer.
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Affiliation(s)
- Sen Wei
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinghao Liu
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Li
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Dong
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingchun Zhao
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Gang Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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Mehdi B, Kaveh H, Ali VF. Implantable Cardioverter-Defibrillators in Patients with ESRD: Complications, Management, and Literature Review. Curr Cardiol Rev 2019; 15:161-166. [PMID: 30657044 PMCID: PMC6719391 DOI: 10.2174/1573403x15666190118123754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/26/2018] [Accepted: 01/10/2019] [Indexed: 01/25/2023] Open
Abstract
Background: Cardiovascular diseases are the leading cause of death among dialysis pa-tients, accounting for about 40% of all their mortalities. Sudden cardiac death (SCD) is culpable for 37.5% of all deaths among patients with end-stage renal disease (ESRD). Implantable cardioverter-defibrillators (ICDs) should be considered in dialysis patients for the primary or secondary preven-tion of SCD. Recent studies on the implementation of ICD/cardiac resynchronization therapy do not exclude patients with ESRD; however, individualized decisions should be made in this group of pa-tients. A thorough evaluation of the benefits of ICD implementation in patients with ESRD requires several large-scale mortality studies to compare and follow up patients with ESRD with and without ICDs. In the present study, we sought to determine and clarify the complications associated with ICD implementation and management thereof in patients suffering from ESRD. Methods: To assess the complications allied to the implementation of ICDs and their management in patients with ESRD, we reviewed available related articles in the literature. Results and Conclusions: ICD implementation in dialysis patients has several complications, which has limited its usage. Based on our literature review, the complications of ICD implementation can be categorized as follows: (1) Related to implantation procedures, hematoma, and pneumothorax; (2) Re-lated to the device/lead such as lead fracture and lead dislodgment; (3) Infection; and (4) Central vein thrombosis. Hence, the management of the complications of ICDs in this specific group of patients is of vital importance.
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Affiliation(s)
- Bayati Mehdi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosseini Kaveh
- Cardiology Resident, MS in Public Health, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vasheghani-Farahani Ali
- Cardiac Primary Prevention, Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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6
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Evranos B, Craven P, Henderson R, Visvaratnam P, Jones S, Sarsam M, Gallagher MM. Half a century of continuous pacing: a living witness to the evolution of a technology. Europace 2019; 21:548-553. [PMID: 30839056 DOI: 10.1093/europace/euy218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
To chart the development of pacing technology and its pitfalls we present the experience of a patient who has benefitted from it but also suffered as a result of it from its earliest days. A 53-year-old physician was referred to us with obstruction of the superior and inferior vena cava on a background of more than 50 years of continuous ventricular pacing and 24 previous pacemaker-related interventions. In a single surgical procedure, his existing pacing system and redundant leads were extracted, the superior vena cava was reconstructed, and a new biventricular pacing system with epicardial leads was implanted. Pacemakers can maintain life and preserve the quality of life for many decades. The quality of this therapy has improved due to advances in the technology and in techniques. Maintaining safe pacing in the very long term requires labour, patience, and ingenuity.
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MESH Headings
- Adolescent
- Adult
- Child
- Child, Preschool
- Humans
- Male
- Middle Aged
- Young Adult
- Atrioventricular Block/therapy
- Cardiac Pacing, Artificial/history
- Cardiac Pacing, Artificial/methods
- Cardiac Resynchronization Therapy/history
- Cardiac Resynchronization Therapy/methods
- Cardiac Resynchronization Therapy Devices/history
- Computed Tomography Angiography
- History, 20th Century
- History, 21st Century
- Imaging, Three-Dimensional
- Inventions
- Pacemaker, Artificial/history
- Plastic Surgery Procedures
- Postoperative Complications/diagnostic imaging
- Postoperative Complications/surgery
- Prosthesis Implantation
- Reoperation
- Superior Vena Cava Syndrome/surgery
- Vascular Surgical Procedures
- Vena Cava, Inferior/diagnostic imaging
- Vena Cava, Inferior/surgery
- Vena Cava, Superior/diagnostic imaging
- Vena Cava, Superior/surgery
- Venous Thrombosis/surgery
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Affiliation(s)
- Banu Evranos
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
| | | | | | - Parthiepan Visvaratnam
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
| | - Sue Jones
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
| | - Mazin Sarsam
- Department of Cardiac Surgery, St George's Hospital, London, UK
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
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Donnelly J, Gabriels J, Galmer A, Willner J, Beldner S, Epstein LM, Patel A. Venous Obstruction in Cardiac Rhythm Device Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:64. [PMID: 29995225 DOI: 10.1007/s11936-018-0664-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Joseph Donnelly
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA.
| | - James Gabriels
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Andrew Galmer
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Jonathan Willner
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Stuart Beldner
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Laurence M Epstein
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Apoor Patel
- Department of Cardiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY, 11030, USA
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8
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Keiler J, Schulze M, Sombetzki M, Heller T, Tischer T, Grabow N, Wree A, Bänsch D. Neointimal fibrotic lead encapsulation - Clinical challenges and demands for implantable cardiac electronic devices. J Cardiol 2017; 70:7-17. [PMID: 28583688 DOI: 10.1016/j.jjcc.2017.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
Every tenth patient with a cardiac pacemaker or implantable cardioverter-defibrillator implanted is expected to have at least one lead problem in his lifetime. However, transvenous leads are often difficult to remove due to thrombotic obstruction or extensive neointimal fibrotic ingrowth. Despite its clinical significance, knowledge on lead-induced vascular fibrosis and neointimal lead encapsulation is sparse. Although leadless pacemakers are already available, their clinical operating range is limited. Therefore, lead/tissue interactions must be further improved in order to improve lead removals in particular. The published data on the coherences and issues related to lead associated vascular fibrosis and neointimal lead encapsulation are reviewed and discussed in this paper.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Martina Sombetzki
- Department for Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Tischer
- Heart Center Rostock, Department of Internal Medicine, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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9
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Chaudhry UA, Harling L, Ashrafian H, Athanasiou C, Tsipas P, Kokotsakis J, Athanasiou T. Surgical management of infected cardiac implantable electronic devices. Int J Cardiol 2016; 203:714-21. [DOI: 10.1016/j.ijcard.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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10
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Piciucchi S, Barone D, Sanna S, Dubini A, Goodman LR, Oboldi D, Bertocco M, Ciccotosto C, Gavelli G, Carloni A, Poletti V. The azygos vein pathway: an overview from anatomical variations to pathological changes. Insights Imaging 2014; 5:619-28. [PMID: 25171956 PMCID: PMC4195836 DOI: 10.1007/s13244-014-0351-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022] Open
Abstract
The azygos venous system represents an accessory venous pathway supplying an important collateral circulation between the superior and inferior vena cava. The aim of this article is to revise the wide spectrum of changes ranging from normal to pathological conditions involving the azygos system. Teaching points • The azygos vein is a collateral venous pathway, becoming a vital shunt if major pathways of venous return are obstructed. • In azygos continuation, the azygos vein becomes significantly enlarged due to inferior vena cava interruption. • Fibrosing mediastinitis is an underestimated acquired disorder. • Fibrosing mediastinitis induces a variable engorgement of collateral veins. • Fibrosing mediastinitis leads to superior vena cava syndrome.
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Affiliation(s)
- Sara Piciucchi
- Radiology Department, Morgagni Pierantoni Hospital, Forlì, Italy,
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11
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Kokotsakis J, Chaudhry UAR, Tassopoulos D, Harling L, Ashrafian H, Vernandos M, Kanakis M, Athanasiou T. Surgical management of superior vena cava syndrome following pacemaker lead infection: a case report and review of the literature. J Cardiothorac Surg 2014; 9:107. [PMID: 24947452 PMCID: PMC4075978 DOI: 10.1186/1749-8090-9-107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 06/13/2014] [Indexed: 11/10/2022] Open
Abstract
Superior vena cava (SVC) syndrome is a known but rare complication of pacemaker lead implantation, accounting for approximately less than 0.5% of cases. Its pathophysiology is due to either infection or endothelial mechanical stress, causing inflammation and fibrosis leading to thrombosis, and therefore stenosis of the SVC. Due to the various risks including thrombo-embolic complications and the need to provide symptomatic relief, medical and surgical interventions are sought early. We present the case of a 48-year Caucasian male who presented with localised swelling and pain at the site of pacemaker implantation. Inflammatory markers were normal, but diagnostic imaging revealed three masses along the pacemaker lead passage. A surgical approach using cardiopulmonary bypass and circulatory arrest was used to remove the vegetations. Culture from the vegetations showed Staphylococcus epidermidis. The technique presented here allowed for safe and effective removal of both the thrombus and infected pacing leads, with excellent exposure and minimal post-procedure complications.
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Affiliation(s)
| | | | | | | | | | | | | | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, UK.
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12
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Saad TF, Ahmed W, Davis K, Jurkovitz C. Cardiovascular implantable electronic devices in hemodialysis patients: prevalence and implications for arteriovenous hemodialysis access interventions. Semin Dial 2014; 28:94-100. [PMID: 24863543 DOI: 10.1111/sdi.12249] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiovascular implantable electronic devices (CIEDs) are frequently utilized in hemodialysis patients. CIED leads are typically implanted via the subclavian vein resulting in stenosis and venous hypertension. We studied 1235 chronic hemodialysis patients under the care of our nephrology practice. For each, we determined the presence of a CIED, indication for implantable cardioverter-defibrillator (ICD), and type of hemodialysis access. Records were reviewed to identify all interventions performed on the access circuit and the central veins specifically. A CIED was present in 129 patients (10.5%), including ICDs in 75 (6.1%) and pacemakers in 54 (4.4%). The access circuit intervention rate was 1.48/access year (AY) and was similar when a CIED was ipsilateral (1.53/AY) or contralateral (1.44/AY) to arteriovenous access (p = 0.477). The rate of central venous interventions was greater in the ipsilateral (0.59/AY) versus contralateral group (0.28/AY), (p < 0.001). Fifty-four of 59 patients with ipsilateral access and CIED required <2 interventions per AY, but six failed angioplasty and required access ligation. None had superior vena cava stenosis requiring intervention. We conclude that there is a high prevalence of CIEDs in our HD patients. Ipsilateral CIED and arteriovenous access results in higher central venous intervention rates compared with contralateral cases; overall access circuit intervention rates are similar.
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Affiliation(s)
- Theodore F Saad
- Nephrology Associates, PA, Vascular Access Center, Newark, DE; Section of Renal & Hypertensive Diseases, Department of Medicine, Christiana Care Health System, Newark, DE
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Steinberg C, Calvaruso D, Guimond J, Bédard E, Perron J. Surgical lead extraction for total occlusion of the superior vena cava by chronic lead infection after mustard procedure. J Card Surg 2014; 29:406-9. [PMID: 24438576 DOI: 10.1111/jocs.12290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a case of total occlusion of the superior vena cava (SVC) with extensive thrombosis of the adjacent large veins secondary to multiple abandoned pacemaker leads with a superimposed chronic lead infection by Corynebacterium jeikeium. A surgical lead extraction was performed with an extensive en-bloc resection of the SVC together with the right subclavian vein and the right innomate vein. No venous reconstruction was required because of an unobstructed runoff via a well-developed azygos system.
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Affiliation(s)
- Christian Steinberg
- Division of Cardiology, Institut Universitaire De Cardiologie Et Pneumologie de Québec (IUCP), Quebec Heart and Lung Institute, Quebec, Canada
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14
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Treatment of pacemaker-induced superior vena cava syndrome by balloon angioplasty and stenting. Neth Heart J 2013; 19:41-6. [PMID: 22020858 DOI: 10.1007/s12471-010-0052-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Superior vena cava (SVC) syndrome is a rare but serious complication after pacemaker implantation. This report describes three cases of SVC syndrome treated with venoplasty and venous stenting, with an average follow-up of 30.7 (±3.1) months. These cases illustrate that the definitive diagnosis, and the extent and location of venous obstruction, can only be determined by venography.
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15
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Lelakowski J, Domagała TB, Rydlewska A, Januszek R, Kotula-Horowitz K, Majewski J, Ząbek A, Małecka B. Relationship between changes in selected thrombotic and inflammatory factors, echocardiographic parameters and the incidence of venous thrombosis after pacemaker implantation based on our own observations. Arch Med Sci 2012; 8:1027-34. [PMID: 23319977 PMCID: PMC3542480 DOI: 10.5114/aoms.2012.28600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 05/13/2011] [Accepted: 08/31/2011] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Thrombosis (VTh) is a rare dangerous complication of pacemaker implantation (PM). The aim of the study was to determine the dynamics of change in selected thrombotic and inflammatory factors after PM. MATERIAL AND METHODS The study involved 81 patients (30 female, mean age: 71.1 years) with PM, divided into two groups. Group A (71 patients) consisted of patients without VTh, whereas group B (10 patients) comprised the patients with VTh. A transthoracic echocardiogram (TTE) and a venous ultrasound (VU) examination were performed. The levels of D-dimers, fibrinogen, tissue factor (TF), factor VII, plasminogen activator inhibitor-1 (PAI-1), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were determined in the venous blood. After PM, the TTE and VU examinations were repeated at 6 and 12 months, and blood analyses were performed within 7 days after PM, and subsequently at 6 and 12 months. RESULTS In 10 patients of group B, symptomatic VTh occurred at a mean time of 13.06 months after PM. Initially, the levels of IL-6, hsCRP, D-dimers, fibrinogen, TF, VII factor and PAI-1 were considerably higher in group B than in group A. In all patients the levels of these factors kept on increasing for up to 7 days after the procedure. In group A they subsequently decreased, whereas in group B they continued to rise. CONCLUSIONS Increased levels of inflammatory and thrombotic factors were observed in patients with VTh before and after PM. The factors of highest risk of VTh occurrence were D-dimers, fibrinogen and TF.
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Affiliation(s)
- Jacek Lelakowski
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Teresa Barbara Domagała
- Department of Internal Medicine, School of Medicine, Jagiellonian University, Cracow, Poland
- Department of Medical Biochemistry, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Anna Rydlewska
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Rafał Januszek
- Department of Internal Medicine, School of Medicine, Jagiellonian University, Cracow, Poland
| | | | - Jacek Majewski
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Barbara Małecka
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
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16
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Takeuchi D, Tomizawa Y. Pacing device therapy in infants and children: a review. J Artif Organs 2012; 16:23-33. [PMID: 23104398 DOI: 10.1007/s10047-012-0668-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 10/10/2012] [Indexed: 01/20/2023]
Abstract
The number of pediatric pacemakers implanted is still relatively small. Children requiring pacing therapy have characteristics that are distinct from those of adults, including physical size, somatic growth, and cardiac anomalies. Considering these features, long-term follow-up of pediatric pacemaker implantation is necessary. Selection of appropriate generators, pacing modes, pacing sites, and leads is important. Generally, epicardial leads are commonly used in small infants. On the other hand, the use of endocardial leads in children is increasing worldwide because of their benefits over epicardial leads, such as minimal invasiveness, lower pacing threshold, and longer generator longevity. Endocardial leads are not suitable for patients with intracardiac shunts because of the high risk of systemic thrombosis. Venous occlusion is another significant problem with endocardial leads. With the increase in the number of pacing device implantations, the incidence of infection from such devices is also increasing. Complete device removal is sometimes recommended to treat device infection, but experience in the removal of endocardial leads in children is still scarce. This article gives an overview of pacing therapy in the pediatric population, including discussions on new pacing systems, such as remote monitoring systems, magnetic imaging compliant pacemaker systems, and leadless pacing devices.
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Affiliation(s)
- Daiji Takeuchi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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17
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Gebreyes AT, Pant HN, Williams DM, Kuehl SP. Be aware of wires in the veins: a case of superior vena cava syndrome in a patient with permanent pacemaker. J Community Hosp Intern Med Perspect 2012; 2:19159. [PMID: 23882380 PMCID: PMC3714072 DOI: 10.3402/jchimp.v2i3.19159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 11/26/2022] Open
Abstract
Superior vena cava (SVC) syndrome is an unusual complication of pacemaker and implantable cardioverter–defibrillator implantation. It is believed to be due to SVC thrombosis with or without stenosis induced by endothelial disruption from repeated mechanical trauma by the leads. A 58-year-old man presented with gradual swelling of his face, neck, and upper extremities of 10 days duration. A pacemaker had been implanted for symptomatic bradycardia over 5 years ago. Venous Doppler and venogram revealed thrombosis and stenosis of the SVC. He was treated with multimodal therapy and was discharged with complete resolution of his symptoms.
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18
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Mulz JM, Kraus MS, Thompson M, Flanders JA. Cranial vena caval syndrome secondary to central venous obstruction associated with a pacemaker lead in a dog. J Vet Cardiol 2010; 12:217-23. [DOI: 10.1016/j.jvc.2010.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 09/01/2010] [Accepted: 09/07/2010] [Indexed: 10/18/2022]
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19
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Lonyai A, Dubin AM, Feinstein JA, Taylor CA, Shadden SC. New insights into pacemaker lead-induced venous occlusion: simulation-based investigation of alterations in venous biomechanics. ACTA ACUST UNITED AC 2010; 10:84-90. [PMID: 20514553 DOI: 10.1007/s10558-010-9096-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Venous obstruction is a major complication of transvenous pacemaker placement. Despite the increasing use of pacemakers and implantable cardiac defibrillators, a lack of understanding remains with regard to risk factors for the development of device-associated venous obstruction. We hypothesize that computational fluid dynamics simulations can reveal prothrombogenic locations and define thrombosis risk based on patient-specific anatomies. Using anatomic data derived from computed tomography, computer models of the superior vena cava, subclavian, innominate, and internal jugular veins were constructed for three adult patients with transvenous pacemakers. These models were used to perform patient-specific simulations examining blood flow velocity, wall shear stress, and blood pressure, both with and without the presence of the pacing leads. To better quantify stasis, mean exposure time fields were computed from the venous blood flow data. In comparing simulations with leads to those without, evident increases in stasis at locations between the leads and along the surface of the vessels closest to the leads were found. These locations correspond to regions at known risk for thrombosis. This work presents a novel application of computational methods to study blood flow changes induced by pacemaker leads and possible complications such as venous occlusion and thrombosis. This methodology may add to our understanding of the development of lead-induced thrombosis and occlusion in the clinical arena, and enable the development of new strategies to avoid such complications.
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Affiliation(s)
- Anna Lonyai
- School of Medicine, Stanford University, Palo Alto, CA, USA
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20
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Maytin M, Epstein LM. Lead Extraction Is Preferred for Lead Revisions and System Upgrades: When Less Is More. Circ Arrhythm Electrophysiol 2010; 3:413-24; discussion 424. [DOI: 10.1161/circep.110.954107] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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RILEY ROBERTF, PETERSEN STEFFENE, FERGUSON JOHND, BASHIR YAVER. Managing Superior Vena Cava Syndrome as a Complication of Pacemaker Implantation: A Pooled Analysis of Clinical Practice. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:420-5. [DOI: 10.1111/j.1540-8159.2009.02613.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Cunningham SM, Ames MK, Rush JE, Rozanski EA. Successful treatment of pacemaker-induced stricture and thrombosis of the cranial vena cava in two dogs by use of anticoagulants and balloon venoplasty. J Am Vet Med Assoc 2009; 235:1467-73. [DOI: 10.2460/javma.235.12.1467] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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A case of pacing lead induced clinical superior vena cava syndrome: a case report. CASES JOURNAL 2009; 2:7477. [PMID: 19829974 PMCID: PMC2740201 DOI: 10.4076/1757-1626-2-7477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 05/16/2009] [Indexed: 11/24/2022]
Abstract
Introduction Transvenous pacing is a relatively safe treatment with a low complication rate, but serious thromboembolic complications have been reported to occur in 0.6% to 3.5% of cases. Superior vena cava obstruction syndrome is generally an uncommon but serious complication occurring in <0.1% of patients. However, when it occurs it carries with it significant morbidity and mortality. Case presentation A 51-year-old lady with long history of DDD permanent pacemaker presented following a mechanical fall. She had no obvious injuries, and was hemodynamically stable. General examination revealed features suggestive of Superior vena caval obstruction which was later confirmed by imaging. She was treated with long term oral anticoagulation with good clinical improvement. Conclusion Superior vena cava obstruction in patients with transvenous pacing leads, although rare, is a well recognized complication. With growing elderly population and increasing number of procedures performed, more and more people with permanent pacemaker are likely to be encountered in clinical practice. One should carefully look for thromboembolic complications during follow-up in patients with transvenous pacemaker leads, as it has implications for future management and carries significant morbidity and mortality.
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24
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Unusual cause of superior vena cava syndrome diagnosed with transesophageal echocardiography. Can J Anaesth 2009; 55:774-8. [PMID: 19138918 DOI: 10.1007/bf03016351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE An unusual case of superior vena cava (SVC) syndrome caused by an infected right atrial-SVC junction thrombus may be diagnosed using transesophageal echocardiography. CLINICAL FEATURES A 59-yr-old male with end-stage renal disease requiring hemodialysis presented with fungemia and later developed facial and bilateral upper extremity edema. Transesophageal echocardiography revealed subtotal occlusion of the SVC at its junction with the right atrium. The mass was surgically removed with cardiopulmonary bypass support. Pathological examination of the mass confirmed the presence of a large fungal colony of Candida species mixed in the thrombus. The patient's signs and symptoms of SVC obstruction resolved, and he was discharged from the hospital four weeks later in stable condition. CONCLUSION Although usually caused by extrinsic tumour compression, SVC syndrome can result from intravascular caval obstruction. This etiology should also be considered in the differential diagnosis, particularly in patients with intravascular devices. Transesophageal echocardiography is a valuable diagnostic tool in these cases.
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25
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26
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Cranial vena caval syndrome secondary to transvenous pacemaker implantation in two dogs. J Vet Cardiol 2008; 10:155-61. [DOI: 10.1016/j.jvc.2008.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 09/18/2008] [Indexed: 11/20/2022]
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27
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Kogon BE, Plattner C, Jennings S, Lyle T, McConnell M, Book WM. Cyanosis Produced By Superior Vena Caval Stenosis. Ann Thorac Surg 2008; 85:1083-5. [DOI: 10.1016/j.athoracsur.2007.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Revised: 09/01/2007] [Accepted: 09/17/2007] [Indexed: 11/29/2022]
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28
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Mediastinum. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Affiliation(s)
- Michael E Field
- Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA
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30
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Chee CE, Bjarnason H, Prasad A. Superior vena cava syndrome: an increasingly frequent complication of cardiac procedures. ACTA ACUST UNITED AC 2007; 4:226-30. [PMID: 17380168 DOI: 10.1038/ncpcardio0850] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 12/12/2006] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 29-year-old woman presented with chest pressure, progressive dyspnea, fatigue, and swelling of her face, neck and upper extremities. Four days earlier, she had undergone a procedure for treatment of inappropriate sinus tachycardia, during which atrioventricular node ablation and implantation of a single-lead VVI pacemaker had been performed following an unsuccessful attempt at sinus node modification. INVESTIGATIONS Physical examination, contrast-enhanced CT of the chest, Doppler ultrasonography of the upper extremities, venography, coagulation studies, echocardiography. DIAGNOSIS Superior vena cava syndrome due to thrombotic obstruction-a complication of a cardiac procedure. MANAGEMENT Anticoagulation, catheter-directed thrombolytic therapy, mechanical thrombectomy, pericardiocentesis.
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31
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Ruge H, Wildhirt SM, Poerner M, Mayr N, Bauernschmitt R, Martinoff S, Lange R. Severe Superior Vena Cava Syndrome after Transvenous Pacemaker Implantation. Ann Thorac Surg 2006; 82:e41-2. [PMID: 17126089 DOI: 10.1016/j.athoracsur.2006.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 08/01/2006] [Accepted: 08/14/2006] [Indexed: 10/23/2022]
Abstract
Superior vena cava syndrome is a rare complication after pacemaker implantation. The present report outlines how underestimation of clinically relevant symptoms of superior vena cava syndrome early after pacemaker implantation may result in severe complication with the need for major surgical intervention. Superior vena cava syndrome should be diagnosed early because immediate thrombolytic therapy is effective in the majority of patients and avoids the requirement for interventional or surgical efforts.
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Affiliation(s)
- Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
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32
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Melzer C, Lembcke A, Ziemer S, Eddicks S, Witte J, Baumann G, Borges AC. Pacemaker-Induced Superior Vena Cava Syndrome: Clinical Evaluation of Long-Term Follow-Up. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1346-51. [PMID: 17201841 DOI: 10.1111/j.1540-8159.2006.00546.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pacemaker-induced superior vena cava (SVC) syndrome is a rare but serious complication of permanent pacemaker implantation. Because of its rarity, little is known about the long-term prognoses of such patients. METHODS Five patients, mean age 62 +/- 11.4 years, with pacemaker-induced SVC syndrome for more than 10 years were investigated. The clinical evaluation included: exercise testing, thrombophilia lab tests, and a chest CT. RESULTS Two of the patients manifested complications of SVC syndrome which included thoracoabdominal subcutaneous collaterals. One of these patients simultaneously developed an increase in the pacing threshold which required the implantation of epicardial leads. Three of the five patients had normal age-adjusted VO(2) AT und VO(2) max. Four of the patients were both heterozygous for a polymorphism of PAI-1 and were homozygous for a polymorphism of t-PA. One of these patients also was heterozygous for a polymorphism of factor V and glycoprotein IIb/IIIa. The chest CTs revealed extensive and varying collateral circulation patterns in all of the patients. CONCLUSIONS The development of pacemaker-induced SVC syndrome is the result of various predisposing factors including thrombophilia. Many patients retain normal age-adjusted cardiopulmonary capacity and demonstrate stable clinical findings on the long-term as the result of the development of extensive collateral vessel systems. The most serious complication was the combination of SVC syndrome and the simultaneous malfunctioning of one of the leads requiring implantation of a new lead.
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Affiliation(s)
- Christoph Melzer
- Department of Internal Medicine, Clinic for Cardiology and Angiology, Charité University Medical Center, Berlin, Germany.
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33
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Breuls NP, Res JCJ. Acute Subclavian or Axillary Vein Occlusion During Biventricular Pacemaker Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1170-3. [PMID: 17038148 DOI: 10.1111/j.1540-8159.2006.00509.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
During biventricular pacemaker implantation, multiple punctures of the subclavian vein were performed and venous occlusion was apparent during the procedure, which in one case was stopped before lead insertion and in the other patient new access has to be forced through the occlusion by removing one of the already implanted leads. For implanting physicians, it is important to know that acute venous occlusion may occur during lead implantation.
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Affiliation(s)
- Nico P Breuls
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
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34
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Sanjeev S, Karpawich PP. Superior vena cava and innominate vein dimensions in growing children : an aid for interventional devices and transvenous leads. Pediatr Cardiol 2006; 27:414-9. [PMID: 16830087 DOI: 10.1007/s00246-006-1133-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 02/10/2006] [Indexed: 11/24/2022]
Abstract
Transvenous (TV) pacing and defibrillation leads are frequently implanted in children as part of treatment for various congenital and acquired rhythm abnormalities. However, the lead-vascular endothelial interaction is not a benign process and is associated with a risk of progressive venous obstruction. Often, this obstruction requires surgical or interventional relief. The risk of obstruction is related to venous diameters at implant and lead size. Since venous diameters are largely unknown at different ages, the purpose of this study was to correlate innominate vein (INN) and superior vena cava (SVC) diameters with body dimensions in growing children.
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Affiliation(s)
- Sanjeev Sanjeev
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201, USA
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35
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Bakir I, La Meir M, Degrieck I, Marien C, Van den Hauwe K, Wellens F. Contralateral Replacement of Pacemaker and Leads Following Laser Sheath Extraction and Concomitant Stenting for Superior Vena Cava Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:1131-4. [PMID: 16221275 DOI: 10.1111/j.1540-8159.2005.00226.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present the case of a 61-year-old man with a history of pacemaker implantation 15 years ago. The patient was admitted with chronic swelling of the right hemithorax and inflammation of the old incision scar after the replacement of pacemaker generator 6 years ago. The patient also presented symptoms and clinical signs of superior vena cava syndrome. Computed tomography of the thorax showed obstruction of the superior vena cava. The surgical procedure consisted of extraction of infected pacemaker system with excimer laser technique followed by dilatation and stenting of the SVC and finally implantation of a new permanent pacemaker system on the left side.
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Affiliation(s)
- Ihsan Bakir
- Department of Thoracic and Cardiovascular Surgery, OLV Hospital, Aalst, Belgium.
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36
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Prasan AM, Girardi P, Glenn D, Ramsay DR. Angioplasty Facilitated Permanent Pacing in de Novo Superior Vena Cava Obstruction. Pacing Clin Electrophysiol 2005; 28:867-9. [PMID: 16105017 DOI: 10.1111/j.1540-8159.2005.00180.x] [Citation(s) in RCA: 1] [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
The finding of complete occlusion of the superior venal cava during the performance of cardiac pacing is rare. We report a case where performance of angioplasty aided the successful completion of permanent pacemaker implantation.
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Affiliation(s)
- Ananth M Prasan
- Department of Cardiology, St George Hospital, Kogarah, Sydney, NSW, Australia.
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37
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Rozmus G, Daubert JP, Huang DT, Rosero S, Hall B, Francis C. Venous Thrombosis and Stenosis After Implantation of Pacemakers and Defibrillators. J Interv Card Electrophysiol 2005; 13:9-19. [PMID: 15976973 DOI: 10.1007/s10840-005-1140-1] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Accepted: 03/24/2005] [Indexed: 10/25/2022]
Abstract
Venous complications of pacemaker/ implantable cardioverter defibrillator (ICD) system implantation rarely cause immediate clinical problems. The challenge starts when patients come for system revision or upgrade. Numerous reports of venous complications such as stenosis, occlusions, and superior vena cava syndrome have been published. We reviewed current knowledge of these complications, management, and their impact on upgrade/revision procedures. One study has suggested that intravenous lead infection promotes local vein stenosis. Another found that the presence of a temporary wire before implantation is associated with an increased risk of stenosis. Although data for ICD leads is based only on three studies-it suggests that the rate of venous complications is very similar to that of pacing systems, and probably data from pacing leads can be extrapolated to ICD leads. Despite 40 years of experience with transcutaneous implanted intravenous pacing systems and dozens of studies, we were unable to identify clear risk factors (confirmed by independent studies) that lead to venous stenosis. Neither the hardware (lead size, number and material) nor the access site choice (cephalic cut down, subclavian or axillary puncture) appears to affect rate of venous complications. A few factors were proposed as predictors of severe venous stenosis/occlusion: presence of multiple pacemaker leads (compared to a single lead), use of hormone therapy, personal history of venous thrombosis, the presence of temporary wire before implantation, previous presence of a pacemaker (ICD as an upgrade) and the use of dual-coil leads. Anticoagulant therapy (for other reasons than pacemaker lead) seemed to have protective antithrombotic effect.
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Affiliation(s)
- Grzegorz Rozmus
- Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, Strong Memorial Hospital, 601 Elmwood Ave., Box 679, Rochester, NY, 14642, USA.
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38
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Park HW, Kim W, Cho JG, Kang JC. Multiple Pacing Lead-Induced Superior Vena Cava Syndrome: Successful Treatment by Balloon Angioplasty. J Cardiovasc Electrophysiol 2005; 16:221-3. [PMID: 15720463 DOI: 10.1046/j.1540-8167.2005.40511.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Hyung-Wook Park
- Division of Cardiology, The Heart Center, Chonnam National University Hospital, Research Institute of Medical Sciences, Chonnam National University, Gwangju, Korea
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39
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Schifferdecker B, Shaw JA, Piemonte TC, Eisenhauer AC. Nonmalignant superior vena cava syndrome: Pathophysiology and management. Catheter Cardiovasc Interv 2005; 65:416-23. [PMID: 15926179 DOI: 10.1002/ccd.20381] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Superior vena cava (SVC) syndrome occurs following obstruction either from external compression or internal thrombosis or scarring. In the past, treatment was limited to medical therapy or surgical bypass but now percutaneous revascularization presents a viable therapeutic option. We present our experience in the percutaneous therapy of patients with nonmalignant SVC syndrome and review the condition with regard to its pathophysiology and management.
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Affiliation(s)
- Branislav Schifferdecker
- Division of Cardiovascular Medicine, Department of Medicine, Saint Vincent Hospital at Worcester Medical Center, Worcester, Massachusetts, USA
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40
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Bolad I, Karanam S, Mathew D, John R, Piemonte T, Martin D. Percutaneous treatment of superior vena cava obstruction following transvenous device implantation. Catheter Cardiovasc Interv 2005; 65:54-9. [PMID: 15810017 DOI: 10.1002/ccd.20326] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study is to assess the feasibility and safety of percutaneous treatment of superior vena cava (SVC) obstruction following transvenous device implantation. SVC obstruction is an uncommon but serious complication that can occur following permanent pacemaker or cardioverter defibrillator implantation utilizing transvenous endocardial leads. The treatment has traditionally been surgical but with the advent of stents, percutaneous approach is becoming popular. We report on the prevalence of SVC obstruction and the safety of its percutaneous catheter-based treatment. This is a retrospective study of SVC obstruction following device implantation in our institution from January 1993 through November 2003. A total of 1,850 permanent pacemaker and 1,200 implantable cardioverter defibrillator initial implants were performed during that period. Three patients developed SVC obstruction following implant (prevalence, 1/1,000 implant). Two patients were males and the mean age at implant was 57 +/- 13 years. Laser lead extraction and SVC angioplasty with or without stenting were performed in all patients. In two of them, this was followed by reimplantation of new systems. There were no procedural complications or mortality. The patients remain free of SVC obstruction symptoms 24 +/- 19 months after treatment. SVC obstruction prevalence after device implantation is low. Percutaneous treatment of SVC obstruction can be safely performed and appears to be effective in maintaining medium-term patency.
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Affiliation(s)
- Islam Bolad
- Cardiac Arrhythmia Service, Lahey Clinic, 41 Mall Road, Burlington, MA 01805, USA
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41
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Bangratz S, Petitpain N, Froment J, Tisserant A, Aliot E, Gillet P. Syndrome cave supérieur et méthysergide. Therapie 2004; 59:477-9. [PMID: 15559552 DOI: 10.2515/therapie:2004080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Billing JS, Sudarshan CD, Schofield PM, Murgatroyd F, Wells FC. Aortic arch homograft as a bypass conduit for superior vena cava obstruction. Ann Thorac Surg 2003; 76:1296-7. [PMID: 14530036 DOI: 10.1016/s0003-4975(03)00694-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Superior vena cava (SVC) obstruction most commonly results from malignant disease of the superior mediastinum, which is amenable to percutaneous stenting. Superior vena cava syndrome can also be caused by transvenous pacemaker electrodes and indwelling venous catheters, when it may be refractory to minimally invasive treatment. We report 2 patients with superior vena cava obstruction treated successfully by a surgical bypass approach using cryopreserved aortic arch homografts.
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Affiliation(s)
- J Stephen Billing
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
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Bracke FA, Meijer A, van Gelder LM. Pacemaker lead complications: when is extraction appropriate and what can we learn from published data? Heart 2001; 85:254-9. [PMID: 11179258 PMCID: PMC1729652 DOI: 10.1136/heart.85.3.254] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- F A Bracke
- Department of Cardiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, Netherlands.
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44
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Mediastinum. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Affiliation(s)
- M L Musumeci
- Clinica Dermatologica and Istituto di Medicina Interna e Medicina d'Urgenza, Università di Catania, Catania, Italy
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46
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Tan CW, Vijitbenjaronk P, Khuri B. Superior vena cava syndrome due to permanent transvenous pacemaker electrodes: successful treatment with combined thrombolysis and angioplasty--a case report. Angiology 2000; 51:963-9. [PMID: 11103866 DOI: 10.1177/000331970005101110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Superior vena cava syndrome is a rare complication of permanent transvenous pacing electrodes. Multiple treatment options are available, namely thrombolytics, venoplasty, stenting, surgery, and combinations of the above, yet initially the optimal approach is uncertain. Whether plain balloon angioplasty provides durable and satisfactory long-term results is equally uncertain. The authors report a patient treated with a combination of local thrombolytic therapy and balloon venoplasty with good long-term outcome at two years of follow-up.
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Affiliation(s)
- C W Tan
- Department of Medicine, Louisiana State University School of Medicine, New Orleans 70112, USA
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47
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de Cock CC, Vinkers M, Van Campe LC, Verhorst PM, Visser CA. Long-term outcome of patients with multiple (> or = 3) noninfected transvenous leads: a clinical and echocardiographic study. Pacing Clin Electrophysiol 2000; 23:423-6. [PMID: 10793428 DOI: 10.1111/j.1540-8159.2000.tb00821.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To prospectively assess the incidence and clinical significance of thromboembolic complications in patients with multiple (> or = 3) noninfected transvenous leads; 48 consecutive patients were evaluated. Half of the patients had two ventricular leads and one atrial lead, 15 patients had two atrial leads and one ventricular lead, while 9 patients had two ventricular and two atrial leads. No additional care was provided except for aspirin (80 mg bid) and annually performed echo-Doppler studies. Clinical follow-up included signs and symptoms of subclavian and/or axillary vein thrombosis, the presence of right congestive heart failure, the number of hospital admissions, and death. Echo-Doppler studies assessed the presence of an enlarged right atrium or ventricle, right atrial or ventricular spontaneous contrast, and the presence of tricuspid regurgitation. During a total follow-up of 7.4 +/- 2.2 years there were no differences in the incidence of clinical variables as compared to age-matched controls with DDD pacemakers. The most common complication was transient venous thrombosis (mostly presenting as venous prominence 1-2 weeks after implantation), which was seen in 17% of the study group versus 15% in controls (NS). Cumulative mortality was not different in both groups (13% in the study group vs 15% in controls). No differences were present with respect to hospital admissions (1.1 +/- 0.27/year in the study group vs 1.2 +/- 0.30/year in the controls). In patients with multiple ventricular leads, tricuspid regurgitation on echo-Doppler studies was more frequent (24%) as compared to controls (4%); however, clinical signs of right heart failure were equally distributed. Thus, patients with multiple (> or = 3) noninfected leads have no clinical adverse outcome during long-term follow-up.
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Affiliation(s)
- C C de Cock
- University Hospital VU, Amsterdam, The Netherlands.
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48
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Leonelli FM, Pisanó E, Requarth JA, Potenza D, Tomassoni G, O'Connor W, Natale A. Frequency of superior vena cava syndrome following radiofrequency modification of the sinus node and its management. Am J Cardiol 2000; 85:771-4, A9. [PMID: 12000059 DOI: 10.1016/s0002-9149(99)00860-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In a series of 35 consecutive patients, the presence of a permanent pacemaker appears to be a strong risk factor for developing superior vena cava syndrome after radiofrequency modification of the sinus node. Treatment of this complication with balloon venoplasty is as effective as surgical repair.
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Affiliation(s)
- F M Leonelli
- Cardiology Department, University of Kentucky, Lexington 40536, USA.
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Slonim SM, Semba CP, Sze DY, Dake MD. Placement of SVC stents over pacemaker wires for the treatment of SVC syndrome. J Vasc Interv Radiol 2000; 11:215-9. [PMID: 10716393 DOI: 10.1016/s1051-0443(07)61468-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- S M Slonim
- Section of Cardiovascular and Interventional Radiology, Palo Alto, CA, USA.
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Lin CT, Kuo CT, Lin KH, Hsu TS. Superior vena cava syndrome as a complication of transvenous permanent pacemaker implantation. JAPANESE HEART JOURNAL 1999; 40:477-80. [PMID: 10611913 DOI: 10.1536/jhj.40.477] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Venous thrombosis induced by a transvenous permanent pacemaker is a common complication. However, superior vena cava (SVC) syndrome caused by pacemaker leads is only occasionally seen and its prevalence has been estimated to be less than 1 in 1000 pacemaker patients. Herein, we report a Taiwanese patient of high grade AV block, who presented with SVC syndrome 2 years after transvenous permanent pacemaker implantation. This case features fibrotic stenosis of the junction of right brachiocephalic trunk and SVC, and an extensive thrombus formation resulting in complete obliteration of the left brachiocephalic vein. The collateral circulation was so delicate that he still could lead a rather normal life, even if anticoagulant therapy proved to be ineffective from an angiographic point of view.
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Affiliation(s)
- C T Lin
- Department of Medicine, Chang Gung University, Taipei, Taiwan
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