Unusual Approach of a Pacemaker Electrode in a Patient with a Silent Superior Vena Cava Syndrome

Abstract

A man with a history of bilateral pectoral pocket infection and subsequent pacemaker implantation with a screw-in epicardial lead was referred because of increasing lead impedance. Venography revealed bilateral total occlusion of the subclavian and innominate veins with extensive collateral formation in this asymptomatic patient. Both internal jugular veins were also totally occluded. Because repeated pacemaker implantation using epicardial leads resulted in increasing lead impedance of the ventricular lead within 1 year after implant, an alternative approach was found using the superior caval vein with minimal invasive thoracotomy for single lead VDD pacing.

Permanent pacemaker lead implantation via azygous vein in a patient with silent superior vena cava syndrome

“…Westerman and Van Dervanter described a transthoracic technique requiring a limited thoracotomy for lead placement through the sixth intercostal space, with the lead being inserted transatrially through an incision using a sheath [11]. As of late times, De Cock et al has reported a case with bilateral subclavian vein occlusion undergoing endocardial pacemaker implantation through superior vena cava due to high impedance of ventricular electrodes, which had previously been implanted epicardially [12].…”

Percutaneous Permanent Pacemaker Implantation Via The Azygous Vein In A Patient With Superior Vena Cava Occlusion

“…Placement of epicardial leads requires surgery and general anesthesia 4 and are associated with a less physiological myocardial activation sequence and therefore inefficient contraction, 5 high lead impedances, 6 and higher stimulation thresholds even with the use of steroid‐eluting leads 7 …”

“…Several approaches for endocardial pacemaker lead placement have been described but many of these require surgery and general anesthesia to access the IVC, 8 the SVC below the level of the SVCO, 6 the azygous vein, 9 or the right atrium (direct transatrial lead placement) 10 …”

An Implantation of DDD Epicardial Pacemaker Through Ministernotomy in a Patient with a Superior Vena Cava Occlusion

“…Endocardial electrode introduction may be difficult or even impossible in patients whose SVC is occluded 2 . In these cases, epicardial leads or different intravenous approaches are selected for VVI or VDD pacemaker lead insertion 2–4 . We reported the combined procedure of epicardial DDD pacemaker implantation through the limited lower sternotomy with placement of the generator in the pectoral subcutaneous pocket.…”