Use of Doppler ultrasound in diagnosing pacemaker-related subclavian vein occlusion following biventricular pacemaker...

Subclavian vein occlusion (SVO) is a common complication following pacemaker implantation.

The study aimed to determine the long-term incidence of SVO following cardiac resynchronization therapy (CRT) implantation using venous Doppler ultrasonography (USG).

This cross-sectional study included 181 patients who underwent CRT implantation and were due for elective battery replacement. Patients in whom venous Doppler USG examination did not reveal subclavian vein flow were pre-diagnosed with SVO. A definitive diagnosis of SVO was made in patients who were pre-diagnosed with SVO using venography on the day of CRT battery replacement. Patients were divided into two groups as patients with and without SVO.

A definitive SVO diagnosis was made in 59 (33%) patients. Patients with SVO were significantly older, were more likely to have hypertension and diabetes mellitus (DM), and had longer duration of CRT implantation than patients without SVO. Venous Doppler USG examination revealed that the respirophasic flow disappeared in all patients with SVO, a continuous flow pattern was present, and the axillary vein flow velocity was significantly lower compared to patients without SVO. Variables found to be significantly associated with SVO in univariate analysis were further evaluated using multivariate logistic regression analysis. Consequently, DM and advanced age were found to be independent variables significantly predicting SVO (p < 0.05 for each case).

Approximately one-third of our sample was diagnosed with definitive SVO in the long term after CRT implantation. Venous Doppler USG is a useful, simple and non-invasive method that can be used for the preliminary diagnosis of SVO.