[Thrombophlebitis on intravenous cardiac stimulator electrodes]

The main feature of venous thrombosis on endocardial pacing electrodes are described with reference to 7 cases: the incidence is relatively low (0.4 to 4 p. 100) and the diagnosis obvious in the typical axillary-subclavian form associated with pain, oedema and collateral circulation. Diagnosis is mainly clinical and rehoplethysmography, rather than venography with its potential complications, is the complementary investigation of choice. Internal jugular, innominate vein, vena cava and intracardiac thrombosis may also occur. The vena cava syndromes are observed mainly in patients with multiple electrodes. Atrial or ventricular endocavitary thrombosis may give rise to hemodynamic signs of cardiac failure or to thromboembolism which may be fatal. Operational technique is an important factor in the etiology of early thrombosis especially when the approach vein is ligatured. In the late period, the loss of venous mobility due to the presence of a foreign body makes the vessel susceptible to compression in the cervico-brachial region. The mainstay of treatment is anticoagulation with intravenous or subcutaneous heparin with mobilisation and elevation of the affected arm. Fibrinolysis may be indicated in superior vena cava syndromes (case no 1), the results being better when therapy is instituted early on. Long term anticoagulation is not indicated (case no 7) and may even be dangerous in elderly patients with multiple electrodes.