Facial swelling: a complication of transvenous pacing

A case of progressive venous thrombosis involving the superior vena cava is reported following implantation of a permanent transvenous pacemaker. Acute symptoms in the arm appeared after 18 months, but the symptoms of superior vena caval obstruction developed gradually, three years after pacemaker insertion. The diagnosis was confirmed by cavography and symptoms resolved with heparin therapy. Long-term anticoagulation is indicated when thrombosis is responsible for this uncommon but important complication of transvenous pacing.