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Bi-atrial subxiphoid epicardial pacemaker in superior vena cava syndrome

Roberto Costa1, Maria Inês de Paula Leão, Kátia Regina da Silva

  • 1Instituto do Coração, Hospital das Clínicas, FM, USP, São Paulo, SP, Brazil. rcosta@cardiol.br

Arquivos Brasileiros De Cardiologia
|November 28, 2006
PubMed

Insights

A patient with a permanent pacemaker developed superior vena cava syndrome. The transvenous system was removed and reimplanted using epicardial access to resolve the obstruction.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Permanent pacemaker implantation is common for managing cardiac arrhythmias like atrial fibrillation and sinus bradycardia.
  • Patients on chronic oral anticoagulation may have increased risks for certain complications.
  • Superior vena cava syndrome (SVCS) is a potentially serious condition affecting venous return to the heart.

Observation:

  • A patient with a permanent pacemaker presented with clinical signs of superior vena cava syndrome.
  • Venography revealed complete blockage of the right brachiocephalic vein and severe narrowing at the left brachiocephalic vein's junction with the superior vena cava.

Findings:

  • The transvenous pacemaker system was identified as the cause of the superior vena cava obstruction.
  • Successful management involved complete removal of the existing transvenous leads.

Implications:

  • Epicardial lead implantation via subxiphoid access offers an alternative approach for pacemaker revision or reimplantation.
  • This case highlights the importance of considering pacemaker hardware as a cause of SVCS in relevant patients.
  • Fluoroscopic guidance is crucial for accurate placement during epicardial lead implantation.

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