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Pacemaker implantation in a patient with a Behçet's disease associated with superior vena cava obstruction
Insights
Behçet's disease patients needing pacemakers may have blocked veins. Angiography before implantation can identify these obstructions, guiding successful surgical approaches like epicardial electrodes.
Area of Science:
- Cardiology
- Vascular Medicine
- Immunology
Background:
- Behçet's disease is a rare systemic vasculitis.
- Venous obstructions can complicate cardiovascular interventions.
- Atrioventricular (A-V) block is a potential cardiac manifestation.
Abstract:
A 65-year-old man with Behçet's disease developed transient complete A-V block with syncope. An attempt to implant a permanent transvenous endocardial electrode failed owing to obstructions in the subclavian, innominate, and superior vena cava veins demonstrated by angiography. Sutureless epicardial electrodes were successfully implanted through a subxyphoid approach. Obstruction in the great veins is a common feature in patients with Behçet's disease. We suggest that patients with this disorder, who require a permanent pacemaker, should be investigated by angiography prior to implant to rule out obstruction in the upper great veins.