0168: Occlusion of superior vena cava due to a pacing lead after an electrification

Abstract

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. A 28-year-old lady with history of DDD permanent pacemaker implantation secondary to a cardiac surgery (mitral and aortic valves replacements). She was unfortunately electrified occasioning a threshold elevation. An attempt to implant a new endocavitary lead failed, the venography showed a partial occlusion of the right subclavicular vein and a total occlusion of superior vena cava with supleance, confirmed by the angioscanner. Her ancient leads were already functional; we replace only the pulse generator. General examination doesn’t revealed features suggestive of superior vena caval obstruction which was later confirmed by imaging. She was treated by continuing her long term oral anticoagulation. 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. In our case despite anticoagulation for mechanic valve replacement the occlusion of the VCS occurred. Cardiac surgery, traumatic placement of ancient leads and latest electrocution probably contributed to this fact. Superior vena cava obstruction in patients with transvenous pacing leads, although rare, is a well recognized complication. 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.