Total venous obstruction following atrioventricular sequential pacemaker implantation

We describe a case of a 79-year-old woman who developed pain and pitting edema of the upper right extremity due to total venous obstruction following the implantation of an atrioventricular sequential pacemaker. She was treated by arm elevation and anticoagulation after which the pain and edema subsided. To our knowledge, this is the first reported case of this complication occurring following implantation of a dual-chamber pacing system. We recommend that venographic studies be done after implantation if apparent arm swelling occurs, and that anticoagulant therapy be instituted if thrombosis is present.