Challenging pacemaker implantation in a patient with a large aortic aneurysm – a case report

Abstract

With the increasing life span of the general population more cases of the aneurysms are being reported within cardiological patients with other vascular morbidities. A 75-year-old woman presented with syncope in the course of third-degree cardiovascular block. During the first day of hospitalization, the interventional cardiologist implanted the temporary endocavitary lead through the internal jugular vein. The following day, the implantation of a pacemaker was performed. During the procedure, it was revealed that the venous system on the left side of the patient’s chest is significantly modified by a large aortic arch aneurysm constricting the left brachiocephalic vein. Due to the usage of a hydrophilic guide wire, the cardiologist managed to gain access through the critically stenosed part of the vein and successfully implant the pacemaker.