Venous obstruction after permanent pacing

In a 10-year prospective study of 6,256 patients (5,812 males, 444 females) with permanent pacemaker, 25 had presented with features of venous obstruction such as pain, swelling or dilated superficial veins of face, upper limb(s) or upper chest wall without congestive heart failure. When subjected to contrast venography, 22 (0.35%) of the cases demonstrated subclavian and/or superior vena cava thrombotic/fibrotic obstruction. Each patient had non-progressive dilated veins over upper chest wall which developed after an average period of six months of implantation and none had embolic events or cephalad propagation of thrombus. Nine patients had subclavian, eight superior vena cava and five had both the vein obstructions. Seven patients of venous obstruction were treated with heparin followed by oral anticoagulants and three patients with oral anticoagulants alone. Three of seven patients got relief of obstruction with combined therapy group (heparin followed by oral anticoagulants) only. Two patients with superior vena cava obstruction needed epicardial pacing during subsequent lead revision. Therefore, before revision of permanent pacemaker leads in patients with signs of venous obstruction, venography can be useful to assess the obstruction and to determine the route of new lead insertion.