Abstract

Case Report

Occluded superior vena cava and failed epicardial pacing: An unorthodox solution

Ranjit K Nath* and Satyam Rajvanshi

Published: 13 January, 2020 | Volume 5 - Issue 1 | Pages: 014-016

Permanent pacemaker implantation is conventionally done via upper limb veins. But in 1% - 6% cases, usual sub clavicular approach is either not possible or contraindicated due to complete occlusion of superior vena cava (SVC) or bilateral subclavian vein and/or bilateral implant site infection or thin skin [1]. Alternative approaches are warranted, including leadless pacemaker or complex lead extraction techniques, before considering surgical epicardial lead placement as a last resort because it has own hazards. We report a patient with complete heart block, total SVC obstruction, and a previously implanted malfunctioning epicardial lead presenting with pacemaker end of life. In view of exhaustion of the surgical option and in a resource constrained situation for lead extraction or leadless pacemaker, transiliac endocardial pacemaker implantation was done and a repeat surgery was averted.

Learning objective: Complete venous occlusion is not very often encountered after pacemaker/ICD implantation. Apart from the risk of general anesthesia and invasive surgery, epicardial leads increase battery drain, and have a shorter operating life compared to an endocardial lead. The sparingly utilized iliac venous approach for permanent pacemaker implantation is a valuable, safe and minimally invasive alternative, when the conventional percutaneous access is unavailable, and surgery is undesirable or not possible. 

Read Full Article HTML DOI: 10.29328/journal.jccm.1001079 Cite this Article Read Full Article PDF

Keywords:

Complete heart block; Pacemaker; Transiliac; Superior vena cava

References

  1. Tsutsumi K, Hashizume K, Kimura N, Taguchi S, Inoue Y, et al. Permanent pacemaker implantation via the iliac vein: An alternative in 4 cases with contraindications to pectoral approach. J Arrhythmia. 2010; 26: 55-61.
  2. Seow S, Lim T, Singh D, Yeo W, Kojodijojo P. Permanent pacing in patients without upper limb venous access: a review of current techniques. Heart Asia. 2014; 6: 163–166. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27326197
  3. Rozmus G, Daubert JP, Huang DT, Rosero S, Hall B, et al. Venous thrombosis and stenosis after implantation of pacemakers and defibrillators. J Interv Card Electrophysiol. 2005; 13: 9-19. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15976973
  4. Burri H. Overcoming the challenge of venous occlusion for lead implantation. Indian Pacing Electrophysiol J. 2015; 15: 110-112. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750115/
  5. Tomaske M, Gerritse B, Kretzers L, Pretre R, Dodge-Khatami A, et al. A 12-year experience of bipolar steroid-eluting epicardial pacing leads in children. Ann Thorac Surg. 2008; 85: 1704-1711. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18442570
  6. El Gamal M, Van Gelder B. Preliminary experience with the helifix electrode for transvenous atrial implantation. PACE. 1979; 2: 444–454. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/95313
  7. Mathur G, Stables RH, Heaven D, Ingram A, Sutton R. Permanent pacemaker implantation via the femoral vein: an alternative in cases with contraindications to the pectoral approach. Europace. 2001; 3: 56-59. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11271953
  8. Ellestad MH, French J. Iliac vein approach to permanent pacemaker implantation. Pacing Clin Electrophysiol. 1989; 12:1030-1033. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2476736
  9. Brueck M, Bandorski D, Kramer W, Rauber K. Inferior Vena Cava Approach to Permanent Pacemaker Implantation. PACE 2007; 30: 813-816. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17547621

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?