Atypical Lead Pathway Leading to Vocal Cord Paralysis and Tracheostomy Following Pacemaker Implantation
Dariusz Jagielski1,2, Jagoda Jacków-Nowicka3, Bruno Hrymniak2
1Faculty of Medicine, Wrocław University of Science and Technology, 50-370 Wroclaw, Poland.
Journal of Clinical Medicine
|July 12, 2025
Summary
Transvenous pacemaker lead placement via axillary or cephalic veins can be complicated by anatomical variations like persistent left superior vena cava (PLSVC) or tortuous pathways, requiring careful monitoring for optimal lead positioning and to avoid collateral vessel entry.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Interventional Cardiology
Background:
- Transvenous pacemaker leads are commonly inserted via the axillary and cephalic veins, typically traversing the subclavian, brachiocephalic, and superior vena cava.
- Standard lead placement relies on predictable venous anatomy for successful access to the heart.
Observation:
- Anatomical variations, such as a persistent left superior vena cava (PLSVC), can complicate standard lead placement.
- Tortuous venous pathways present another challenge, increasing the risk of lead deviation.
- Atypical venous courses and collateral vessel engagement (e.g., inferior thyroid vein) can occur during lead insertion.
Findings:
- PLSVC and tortuous venous anatomy necessitate alternative strategies for pacemaker lead placement.
- Close procedural monitoring is essential to ensure the lead follows the intended path and to detect inadvertent entry into collateral veins.
- Leads may reach the heart via unconventional routes due to anatomical challenges.
Implications:
- Unusual lead courses, even without immediate complications, carry unpredictable long-term outcomes.
- The presence of leads in anomalous positions poses a risk of unforeseen complications.
- Identifying and managing anatomical variations are critical for successful and safe transvenous lead implantation.
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