Prevalence and predictor factors of severe venous obstruction after cardiovascular electronic device implantation

Abstract

In patients with implantable devices, severe venous obstruction prevalence is not negligible and the lack of symptoms does not exclude it. The presence of three leads and sudden cardiac death as indication for implantable devices seem to be associated with the presence of severe venous obstruction/occlusion.

Is ventricular sensing always right, when it is left?

“…This is especially required because of the loss of lead interchangeability due to the adoption of DF‐4 leads and quadripolar LV leads. While single chamber ICD candidates are already taking advantage of non‐transvenous devices and leadless technology, leadless CRT is still at an exploratory stage, thus CRT recipients can significantly benefit of this feature to reduce unnecessary and potentially dangerous lead‐related procedures. Future technologic developments should target the clinical needs of CIED recipients while helping to minimize complications, as for the case of the subcutaneous ICD …”

Balloon venoplasty opens the road for an implantable defibrillator patient with complex stenosis

“…Mechanical wall stress causes inflammation and fibrosis, which can ultimately result in venous obstruction. In ICD patients, total venous occlusion is found in 9% of patients; up to 25% of patients show some degree of stenosis .…”

“…We report on a case in which cooperation between device and PCI operators using the equipment typically reserved for coronary interventions allowed us to complete a successful balloon venoplasty and subsequently implant an ICD‐DR in a patient with significant venous stenosis. In up to half of pacemaker implantations, significant occlusions due to fibrosis and/or thrombus will be encountered , and severe occlusion is found in 11% of cases . Mechanical wall stress causes inflammation and fibrosis, which can ultimately result in venous obstruction.…”

Upper extremity deep venous thrombosis and pulmonary embolism after transvenous lead replacement or upgrade procedures

“…The pathogenesis of venous thromboembolic events in CIED patients is multifactorial and risk factors for its occurrence vary widely among the published studies 1‐11 . Endothelial injury during the implantation or removal of CIED leads may cause an inflammatory response, as well as the release of coagulation factors and the development of collateral circulation, which together favors the maintenance of a prothrombotic state and the reduction of a venous flow in the affected territory 4,5 . Thus, endothelial lesion, venous stasis, and hypercoagulability state, which are the three main pathophysiological mechanisms of venous thromboembolism, are present during lead replacement or upgrade procedures and may present cumulative effects 13 …”

“…Transvenous lead implantation of cardiac implantable electronic devices (CIED) is associated with high rates of venous lesions and risk factors for this occurrence have already been identified 1‐6 . Although there is evidence that the use of warfarin in the first 6 months after the initial implantation of these devices reduces the rate of occurrence of venous obstructions, 7 its prevention has not been routine, due to the low incidence of important clinical events such as upper extremity deep venous thrombosis (UEDVT) ipsilateral to the implant, superior vena cava syndrome or pulmonary embolism (PE).…”