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Thrombotic complications with pacemakers
Insights
Permanent pacemaker leads can cause thrombotic complications, including venous occlusion. Severed leads lead to severe symptoms, making their removal mandatory to prevent serious health issues.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Imaging
Background:
- Permanent pacemaker implantation is common for cardiac rhythm management.
- Venous access for lead placement can lead to thrombotic complications.
- The long-term effects of pacemaker leads on venous vasculature require further investigation.
Purpose of the Study:
- To analyze the incidence and characteristics of thrombotic complications following permanent pacemaker lead implantation.
- To compare thrombotic complications in patients with standard lead placement versus those with severed leads.
Main Methods:
- Brachial phlebography was performed in 100 patients (Group 1) ~44 months post-pacemaker implantation.
- Phlebography was also performed in 12 patients (Group 2) with severed pacing leads.
- Clinical history and physical examination were used to assess venous flow impairment.
Main Results:
- 39% of Group 1 patients showed thrombotic lesions; 10% had impaired venous flow based on history, and 12% based on clinical signs.
- Complete venous occlusion occurred in 15 patients, with collateral formation observed.
- All 12 patients in Group 2 (severed leads) exhibited thrombotic complications, with 11 showing clinical symptoms.
Conclusions:
- Thrombotic complications, including segmental venous occlusion, occur in a significant portion of patients after permanent pacemaker lead placement.
- Severed pacing leads result in a high incidence of symptomatic thrombotic complications, necessitating their removal.
- Early detection and management of venous complications associated with pacemaker leads are crucial for patient outcomes.
Abstract:
To analyze thrombotic complications, we performed brachial phlebographies in 100 consecutive patients (group 1), about 44 months after permanent pacemakers had been installed. Thirty-nine patients showed thrombotic lesions in the veins used to pass the stimulation electrode into the right ventricle. In 10 patients the medical history and in 12 patients clinical symptoms and signs indicated an impairment of venous flow. Fifteen of the 39 patients showed complete occlusion of one venous segment; collateral vessel formation was found dependent on the site and the extent of the occlusion. In the remaining 24 patients only partial occlusion without collateralization was demonstrated. Group 2 comprised 12 patients in whom the pacing lead originally inserted via right-sided veins had been severed and the free distal end left unsecured intraluminally when the second electrode was inserted via the left-sided cephalic vein. In all these patients phlebography about 19 months later revealed thrombotic complications, while 11 presented with clinical symptoms and signs. The incidence of thrombotic complications including segmental occlusion after the application of permanent pacer leads is only one-third of patients with segmental occlusion symptoms. However, since severed leads produce severe symptomatic complications in almost all cases their removal is mandatory.