Transvenous lead placement and its pre-sternal tunneling to the contralateral side as a solution for pacemaker system upgrade in case of the subclavian vein thrombosis

Abstract

Introduction Chronic right ventricular pacing can deteriorate cardiac function. Consequently, pacemaker system upgrades are more frequently indicated. These interventions can be hindered by venous thrombosis. In literature, it is rarely described that this problem is resolved by implanting a new lead for left ventricle (LV) stimulation on the opposite side of the previously implanted pacemaker and then subcutaneously transferring it to the old pocket. Case outline A 75-year-old male patient was hospitalized due to a planned pacemaker upgrade in December 2015. A dual-chamber pacemaker had been implanted due to sinus node dysfunction in 2011. During the previous 18 months he had been complaining about symptoms of heart failure. An upgrade to the cardiac resynchronization therapy (CRT) with a new CRT-P device was indicated due to the LV dilatation with the ejection fraction decrease, clinical deterioration, and the presence of high percentage of ventricular pacing. In October 2015, the mentioned intervention was unsuccessful due to total left subclavian vein thrombosis on the side of the previously implanted pacemaker. Anticoagulation therapy was ordinated and the reevaluation was postponed. During this hospitalization, venography confirmed total left subclavian vein thrombosis despite the anticoagulation therapy. It was decided to implant a new LV lead on the right side and then subcutaneously shift it by pre-sternal tunneling to the previous left prepectoral pocket. The intervention was uneventful. The first controls have shown stable pacemaker parameters. Conclusion This case report confirms that contralateral lead placement and subcutaneous pre-sternal tunnelling of the lead is feasible and safe in patients with an implanted pacemaker, an indication for system upgrade and ipsilateral vein obstruction.

New developments, treatment options and possible complication in complex coronary artery disease, structural and congenital heart disease and heart failure

“…and devices for the treatment of coronary artery disease, structural heart diseases, including valvular and congenital heart disease, as well as heart failure, have changed the practice of modern cardiology. In this issue of the Serbian Archives of Medicine we present five articles on different novel techniques, devices, as well as complications of device implantation for the treatment of chronic total occlusion [1], aortic valve disease [2], patent ductus arteriosus [3], pacemaker systems upgrade [4], and finally critical analysis of the most common complications during the implantation of cardiac rhythm management devices [5].…”

“…Moreover, CRT devices have been used to upgrade older pacemaker systems in cases of adverse effects of chronic right ventricular pacing that may lead to heart failure. Here, Radovanović et al [4] present a case of a patient in whom the upgrade of the pacemaker was needed due to a newly developed heart failure. The case was further complicated by subclavian vein thrombosis on the side of the previously implanted pacemaker.…”