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Leadless pacemakers as a new alternative for pacemaker lead-related superior vena cava syndrome: A case report

Antonio Curnis1, Antonino Milidoni1, Gianmarco Arabia1

  • 1Cardio-thoracic department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Brescia, Italy.

Pacing and Clinical Electrophysiology : PACE
|May 17, 2022
PubMed

Insights

Superior vena cava (SVC) syndrome, often caused by pacemaker leads, can be treated with lead extraction and leadless pacemakers. This case highlights a successful treatment combining lead extraction, leadless pacing, and angioplasty for SVC restenosis.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Medical Devices

Background:

  • Superior vena cava (SVC) syndrome is a rare but serious condition often linked to indwelling devices like pacemakers.
  • The incidence of SVC syndrome associated with central venous catheters and pacemaker/defibrillator leads is rising.
  • Current treatment strategies for device-related SVC syndrome, especially after lead extraction, are not fully established.

Observation:

  • Pacemaker lead extraction can cause mechanical trauma, potentially leading to venous occlusion.
  • Subsequent device implantation on the opposite side may further contribute to venous occlusion.
  • A clinical case of pacemaker lead-related SVC syndrome was managed at our centers.

Findings:

  • The patient underwent transvenous lead extraction for SVC syndrome.
  • A leadless pacemaker was implanted following lead extraction.
  • Percutaneous angioplasty and stenting of the SVC and left innominate vein were performed.

Implications:

  • Leadless pacemakers may offer a promising alternative to reduce the risk of SVC restenosis post-lead extraction.
  • This multimodal approach (lead extraction, leadless pacing, angioplasty/stenting) effectively treated SVC syndrome in this case.
  • Further research into leadless pacing could optimize management of device-related SVC syndrome.

Keywords:
cardiac implantable electronic devicesleadless pacemakerpercutaneous angioplastysuperior vena cava syndrometransvenous lead extraction

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