Venous Obstruction After Pacemaker Implantation

Abstract

This is the first systematic study to quantify venous changes after PM or ICD implantation. Our study shows that venous anomalies rendering PM implantation difficult are not infrequent. The incidence of new venous obstruction was 14%. Atrial fibrillation and biventricular PM implantation were independent predictors of venous obstruction.

Varfarina previne obstruções venosas pós-implante de dispositivos cardíacos em pacientes de alto risco: análise parcial

“…Digital subtraction venography, as utilized in most recent studies, has allowed a more precise evaluation of the venous territory, increasing the diagnostic precision, which was previously restricted to severe or total obstructions. With this methodology, the estimated incidence of lesions ranges from 14 to 64% of total implantations [1][2][3][4][5][6][7][8][9][10][11][12]. The incidence of venous lesions of 57.1%, observed in the Placebo Group of the current study, is in agreement with the results reported by most of these studies [1][2][3][4][5][6][7][8][9][10][11][12].…”

“…Recently, other risk factors have been described such as infection [7], lack of anticoagulation therapy [9,12], female hormones [9], previous history of thrombosis [9], multiple electrodes [9], atrial fibrillation [11], multisite pacemakers [11], previous implantation of a definitive pacemaker [8] and implantable cardioverter-defibrillator electrode lead with a double coil [8].…”

“…With the high risk of venous lesions, 3% to 10% of patients present with clinical manifestations, of which, deep venous thrombosis of the arms is the commonest complication [1][2][3][4][5][6][7][8][9][10][11][12]. Severe complications, such as pulmonary embolism and superior vena cava syndrome, with rates that vary between 0.6% and 5%, have been rarely described in the literature, [13][14][15][16][17].…”

“…Prevention of these complications is important both because of their high incidence and clinical manifestations and the difficulties of reoperations to substitute or implant additional electrode leads and to perform other diagnostic or therapeutic interventions that depend on this venous access [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The lack of contusion-related evidence that justifies the use of prophylactic strategies thus demonstrating their efficacy and safety impedes the routine application of this stratagem.…”

“…Venous obstructions after transvenous implantation of electronic cardiac devices have been described as the commonest complication related to this approach [1][2][3][4][5][6][7][8][9][10][11][12], with ventricular dysfunction and the presence of temporary pacemakers ipsilateral to the implantation side being risk factors for its occurrence [6].…”