Venous Obstruction After Pacemaker Implantation

Autor:	Pasi Karjalainen, F.E.S.C. K.E. Juhani Airaksinen M.D., Juha Lund, Petri Korkeila, Juhani Koistinen, Antti Ylitalo, Kai M. Nyman
Rok vydání:	2007
Předmět:	Male Pacemaker Artificial medicine.medical_specialty Venography Internal medicine medicine Humans Persistent left superior vena cava Vein Aged Ultrasonography Venous Thrombosis medicine.diagnostic_test business.industry Cardiac Pacing Artificial General Medicine Venous Segment medicine.disease Venous Obstruction Electrodes Implanted Surgery Equipment Failure Analysis Stenosis Venous thrombosis Treatment Outcome medicine.anatomical_structure Cardiology Female Cardiology and Cardiovascular Medicine Axillary vein business
Zdroj:	Pacing and Clinical Electrophysiology. 30:199-206
ISSN:	1540-8159 0147-8389
DOI:	10.1111/j.1540-8159.2007.00650.x
Popis:	Background: Central vein leads are known to predispose to venous obstruction. Although usually asymptomatic, obstruction may render electrode removal difficult. This study aimed at quantifying changes in venous calibers in a prospective fashion by intravenous contrast venography (ICV) before and after pacemaker (PM) or cardioverter-defibrillator implantation. Methods: One hundred and fifty (mean age 67; 61% male) consecutive patients were enrolled, and followed for 6 months. A successful ICV was done at baseline prior to implantation and at 6-month follow-up in 136 (91%) patients. Minimum (Dmin) and maximum (Dmax) vessel diameters were obtained from both ICVs. A new stenosis was defined as a 50% diameter reduction in a venous segment when compared to baseline. We implanted a total of 230 electrodes: 47 (34.6%) single lead, 84 (61.8%) 2-lead, and 5 (3.7%) 3-lead systems. Results: At baseline ICV, 10 patients (7%) were found to have venous anomalies, including 8 patients with obstructive lesions, 1 patient with a persistent left superior vena cava, and 1 patient with double axillary vein. At 6 months, a new obstructive venous lesion had developed in a total of 19 (14%) patients, none of whom exhibited any local symptoms. Of these patients 14 (10%) had a stenosis (mean Dmin 4.6 mm and diameter 38% of baseline), and 5 (3.6%) had a complete venous occlusion. In most cases the new stenosis developed in a location where the vessel was narrowest at baseline. Clinical predictors for the development of stenosis were atrial fibrillation at baseline and biventricular PM implantation. Conclusions: This is the first systematic study to quantify venous changes after PM or ICD implantation. Our study shows that venous anomalies rendering PM implantation difficult are not infrequent. The incidence of new venous obstruction was 14%. Atrial fibrillation and biventricular PM implantation were independent predictors of venous obstruction.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e683026cf0cc8139b6cbe1ec2c4af83a https://doi.org/10.1111/j.1540-8159.2007.00650.x Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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