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[Infection and superior vena cava syndrome after pacemaker implantations: major consequences of a minor intervention]
E P de Kluiver1, J C Hoorntje, F G Leicher
1Afd. Cardiologie, Ziekenhuis De Weezenlanden, Zwolle.
Abstract:
Two men, aged 71 and 56 years, with pacemakers, developed the superior vena cava syndrome one and five years, respectively, after infection of the pacemaker pocket. They had been treated with antibiotics and partial removal of the foreign bodies. The conditions of both included occlusion of the superior vena cava and of both subclavian veins. The symptoms disappeared after removal of the total pacemaker system and venous reconstruction. The possibility of a superior vena cava syndrome occurring is increased if other complications have occurred previously, particularly infection. Prevention and treatment comprise on the one hand prevention and treatment of the infection (which is not always obvious) and on the other, earliest possible detection of thromboembolisms.
Insights
Pacemaker infections can lead to superior vena cava syndrome, causing vein blockage. Complete pacemaker removal and venous reconstruction resolved symptoms in two patients.
Area of Science:
- Cardiology
- Vascular Surgery
- Infectious Diseases
Background:
- Pacemakers are crucial for cardiac rhythm management.
- Infection of the pacemaker pocket is a known complication.
- Superior vena cava syndrome (SVCS) can arise from various causes, including indwelling devices.
Observation:
- Two patients with pacemakers developed SVCS one and five years post-implantation.
- Both patients had a history of pacemaker pocket infection.
- Clinical presentation included occlusion of the superior vena cava and subclavian veins.
Findings:
- Infection significantly increases the risk of SVCS in pacemaker patients.
- Partial removal of foreign bodies and antibiotics were insufficient for resolution.
- Complete pacemaker system removal and venous reconstruction led to symptom resolution.
Implications:
- Early detection and management of pacemaker pocket infections are critical.
- Vigilance for SVCS is warranted in patients with prior pacemaker complications.
- Comprehensive treatment involving device removal and vascular repair is effective for SVCS in this context.