Venous Obstruction After Pacemaker Implantation
- 28 February 2007
- journal article
- research article
- Published by Wiley in Pacing and Clinical Electrophysiology
- Vol. 30 (2), 199-206
- https://doi.org/10.1111/j.1540-8159.2007.00650.x
Abstract
Central vein leads are known to predispose to venous obstruction. Although usually asymptomatic, obstruction may render electrode removal difficult. This study aimed at quantifying changes in venous calibers in a prospective fashion by intravenous contrast venography (ICV) before and after pacemaker (PM) or cardioverter-defibrillator implantation. One hundred and fifty (mean age 67; 61% male) consecutive patients were enrolled, and followed for 6 months. A successful ICV was done at baseline prior to implantation and at 6-month follow-up in 136 (91%) patients. Minimum (D(min)) and maximum (D(max)) vessel diameters were obtained from both ICVs. A new stenosis was defined as a 50% diameter reduction in a venous segment when compared to baseline. We implanted a total of 230 electrodes: 47 (34.6%) single lead, 84 (61.8%) 2-lead, and 5 (3.7%) 3-lead systems. At baseline ICV, 10 patients (7%) were found to have venous anomalies, including 8 patients with obstructive lesions, 1 patient with a persistent left superior vena cava, and 1 patient with double axillary vein. At 6 months, a new obstructive venous lesion had developed in a total of 19 (14%) patients, none of whom exhibited any local symptoms. Of these patients 14 (10%) had a stenosis (mean D(min) 4.6 mm and diameter 38% of baseline), and 5 (3.6%) had a complete venous occlusion. In most cases the new stenosis developed in a location where the vessel was narrowest at baseline. Clinical predictors for the development of stenosis were atrial fibrillation at baseline and biventricular PM implantation. This is the first systematic study to quantify venous changes after PM or ICD implantation. Our study shows that venous anomalies rendering PM implantation difficult are not infrequent. The incidence of new venous obstruction was 14%. Atrial fibrillation and biventricular PM implantation were independent predictors of venous obstruction.Keywords
This publication has 24 references indexed in Scilit:
- Markers of hypercoagulability and inflammation predict mortality in patients with heart failureJournal of Thrombosis and Haemostasis, 2006
- The Relationship Between Aldosterone, Oxidative Stress, and Inflammation in Chronic, Stable Human Heart FailureJournal of Cardiac Failure, 2006
- Endothelial Activation, Dysfunction, and Damage in Congestive Heart Failure and the Relation to Brain Natriuretic Peptide and OutcomesThe American Journal of Cardiology, 2006
- Percutaneous treatment of superior vena cava obstruction following transvenous device implantationCatheterization and Cardiovascular Interventions, 2005
- Multiple Pacing Lead‐Induced Superior Vena Cava Syndrome: Successful Treatment by Balloon AngioplastyJournal of Cardiovascular Electrophysiology, 2005
- Incidence and Risk Factors of Early Venous Thrombosis Associated with Permanent Pacemaker LeadsJournal of Cardiovascular Electrophysiology, 2004
- Relation of C-reactive protein correlates with risk of thromboembolism in patients with atrial fibrillationThe American Journal of Cardiology, 2004
- Arm Edema, Subclavian Thrombosis, and PacemakersAngiology, 1998
- Bilateral subclavian vein thrombosis soon after pacemaker insertionInternational Journal of Cardiology, 1996