Short-Term Thrombosis after Transvenous Permanent Pacemaker Insertion

In order to assess prospectively the incidence and significance of venous thrombosis early after permanent transvenous pacemaker implantation venographic studies were carried out in 40 consecutive patients. The venograms performed between 1 and 6 months (mean 4 months) after the implantation were normal in 31 patients (77%), in six patients (15%) they showed partial venous obstruction and in three patients (8%) total obstruction. Between 6 and 12 months (mean 9 months) the venograms of five patients, that were previously normal, showed partial venous thrombosis. No changes were found in the venograms performed later. Only two of 14 patients with thrombosis of the great veins was clinically symptomatic and developed arm edema, that resolved spontaneously within about a month. No difference in incidence of abnormal venograms was found according to the type of insulation, the polarity of the electrode and the route of entry.     

Incidence and risk factors of upper extremity deep vein lesions after permanent transvenous pacemaker implant: a 6-month follow-up prospective study

The incidence of venous lesions after permanent pacemaker insertion is around 45%. However, this incidence has been based on retrospective studies in a small series; moreover, factors predicting the development of these venous injuries have not been clearly defined. The aim of this study was to identify the risk factors for higher incidence of upper extremity deep vein thrombosis after transvenous permanent pacemaker insertion. The study included 229 patients and the criteria were age above 12 years and first permanent transvenous pacemaker implant. Exclusion criteria were pulmonary embolism, lower or upper extremity deep venous thrombosis, previous use of central venous catheters, coagulation disturbances, and malignancy. Age, race, sex, underlying cardiac disease, functional class to heart failure, LVEF, venous access, number, material and caliber of the leads, and previous use of a transvenous temporary pacemaker were considered. Six months after the pacemaker was implanted, 202 patients were submitted to digital subtraction venography ipsilateral to pacemaker implant. The venographies were normal in 73 (36%) patients and abnormal in 129 (64%) patients. Patients with previous use of transvenous temporary leads (P = 0,0001, OR = 4,260, confidence limits = 2,133-8,465) and LVEF < or = 40% (P = 0,0378, OR = 3,437, confidence limits = 1,064-12,326), had higher incidence of venous lesions. Previous use of a temporary pacemaker and LVEF < or = 0.40 were considered independent risk factors to a higher incidence of venous stenosis or thrombosis 6 months after permanent pacemaker insertion.     

Superior vena cava stenting and transvenous pacemaker implantation (stent and pace) after the Mustard operation

Summary The Mustard operation for transposition of the great arteries is associated with good long-term survival. Typical complications at follow-up include progressive loss of sinus node function requiring permanent pacemaker implantation, and systemic venous pathway obstruction often precluding a transvenous approach to pacing. We report on 7 patients (median age 14.1; range 5–19) with bradyarrhythmia requiring permanent pacemaker implantation with associated stenosis (n = 6) or occlusion (n = 1) of the superior vena cava, in whom stent implantation relieved the obstruction and facilitated subsequent transvenous permanent pacing. In five of them stenting and pacemaker implantation were performed during a single procedure; two patients underwent elective pacemaker implantation 6 weeks later. In one patient the pacemaker had to be explanted due to pacemaker pocket infection. In the others the follow-up has been uneventful, with excellent chronic pacing thresholds and appropriate sensing. Two patients have had their generator replaced electively. We conclude that stenting of the SVC stenosis allows implantation of transvenous pacemaker leads with good intermediate term results in patients with a Mustard operation for transposition of the great arteries.     

Venous Obstruction Due to Permanent Transvenous Pacemaker Electrodes: Treatment with Percutaneous Transluminal Balloon Venoplasty

Transvenous placement of permanent pacemaker leads is currently the most common method for permanent cardiac pacing. Venous abnormalities, in particular venous stenosis or thrombosis (or both) frequently have been described, although most patients remain asymptomatic because of the development of an adequate venous collateral circulation. Venous obstruction often first becomes apparent during pacemaker lead revision, when difficulty passing the new pacing lead is encountered. In this report, we present two cases of venous stenosis and thrombosis due to permanent transvenous pacemaker electrodes and the use of percutaneous transluminal balloon venoplasty to relieve the venous obstruction.     

Venous Access Thrombosis Detected by Transcutaneous Vascular Ultrasound in Patients with Single-Polyurethane-Lead Permanent Pacemaker

In order to assess the incidence of significant venous thrombosis after transvenous permanent pacemaker implantation, transcutaneous ultrasound studies were performed in 109 consecutive patients with single-polyurethane-lead pacemakers. Ultrasonic evaluation was found to be a good noninvasive method in assessing the veins. Six patients (5.5%) were found to have significant venous obstruction in the subclavian vein. However, none of them were symptomatic. No difference in the incidence of venous obstruction was found, based on the age, duration of implantation, operative technique, potentially thrombogenic factors including atrial fibrillation, diabetes mellitus, hypertension, heart failure and end-stage renal disease.     

Venous complications after insertion of a transvenous pacemaker.

We reviewed the incidence, clinical features, current diagnostic evaluations, and treatments of venous complications that can occur after implantation of a transvenous pacemaker. Of the approximately 80 published articles on the potential venous complications after implantation of a permanent transvenous pacemaker, we selected 63 that addressed the clinical features, diagnosis, and treatment of pacemaker lead-induced venous thrombosis, which occurs in approximately 30 to 45% of patients early or late after implantation of a transvenous pacemaker. Most patients with chronic deep venous thrombosis remain asymptomatic because of the development of an adequate venous collateral circulation. Clinical features of pacemaker lead-induced deep venous thrombosis, although rare, are easily recognized. They should be sought routinely during follow-up of all patients with transvenous pacemaker leads because venous obstruction can interfere with intravenously administered therapy, monitoring of central venous pressure, and revision of a pacemaker lead. Acute deep venous thrombosis is likely to be symptomatic. Early recognition and treatment of acute deep venous thrombosis may help to decrease the potential morbidity and mortality. The definitive diagnosis of pacemaker lead-induced venous thrombosis necessitates contrast-enhanced or digital subtraction venography. Management includes anticoagulation, thrombolytic therapy, surgical intervention, and, recently, percutaneous transluminal balloon venoplasty and depends on the duration, extent, and site of venous occlusion as well as the accompanying symptoms.     

Recurrent Pulmonary Embolization Following Implantation of Transvenous Pacemaker

A 44-year-old man developed recurrent pulmonary embolization after implantation of a permanent transvenous DVI pacemaker connected to polyurethane leads. Thrombus was found in the left innominate and subclavian veins around the pacemaker leads, but not in the right atrium or in the venous system of the pelvis and the lower extremities. The recurrence of pulmonary embolization followed discontinuation of treatment with Coumadin. This case demonstrates that lifelong anticoagulation is indicated in patients who have had pulmonary embolization and/or venous thrombosis around the pacemaker leads.     

永久起搏器植入术患者发生深静脉血栓的调查分析及护理对策

【】目的 探讨我院永久起搏器植入术患者发生深静脉血栓(DVT)的原因及护理对策。方法 回顾性调查我院心内科(CCU,心内一、心内二)收治的425例患者中深静脉血栓(DVT)的发生情况,并分析可能影响永久起搏器植入患者发生DVT的相关因素。结果 永久起搏器植入术患者深静脉血栓的发生率为7.53％,多因素分析显示：永久起搏器植入术患者深静脉血栓与患者年龄、BMI值、吸烟史、     

永久起搏器植入术患者发生深静脉血栓的调查分析

目的通过调查了解永久起搏器植入术患者发生深静脉血栓(DVT)的原因。方法回顾性调查2009年1月—2011年12月收治于同济大学附属第十人民医院永久起搏器植入术的患者425例,分析DVT的发生情况和影响因素。结果永久起搏器植入术患者DVT的发生率为7.53%。多因素分析显示,DVT发生与患者年龄、体质指数(BMI)、吸烟史、术后制动时间、DVT病史和基础疾病有密切相关,具有统计学意义(P0.05)。结论针对永久起搏器植入术患者发生DVT的危险因素,进行早期护理干预,可降低DVT的发生率。     

Recurrent pacemaker lead induced axillary subclavian vein thrombosis

This report describes a patient with two recurrences of axillary subclavian vein thrombosis more than 1 year after implantation of a permanent transvenous pacemaker. Both recurrences were successfully treated with local thrombolysis.     

程序式功能锻炼表在预防起搏器术后上肢深静脉血栓中的应用

目的:通过程序式功能锻炼表预防起搏器植入术后深静脉血栓的形成。方法:将功能锻炼的方式、方法、锻炼时间列成程序表,应用于永久性心脏起搏器植入术后患者中。分别在术后7 d及1,3,6,12个月时抽血复查血浆D-二聚体,观察术侧肢体深静脉血栓形成情况。结果:随访1年患者均未检测到深静脉血栓的形成,无颈肩痛、肩周炎等并发症发生,术后恢复顺利,临床治疗效果满意。结论:永久起搏器植入术后程序式的功能锻炼能够有效降低上肢深静脉血栓的发生,促进功能恢复,减少术后并发症,提高临床治疗效果。     

A Right Atrial Mass in the Presence of a Permanent Pacemaker Electrode in a Patient with Polycythemia Vera

A case of a huge right atrial mass that developed 2 years after a permanent pacemaker implantation is described. The patient had a history of polycythemia vera, which is known to present a high tendency towards the development of thrombosis. In light of this fact, we suggest that in similar cases a full echocardiography follow-up should be performed, and long-term anticoagulant therapy should be considered in selected cases.     

Biventricular Pacing Using Two Pacemakers and the Triggered VVT Mode

O'COCHLAIN, B., et al. : Biventricular Pacing Using Two Pacemakers and the Triggered VVT Mode. Pacemaker dependent patients exhibit interventricular conduction delay due to right ventricular lead placement. The addition of a transvenous coronary sinus lead for biventricular pacing has been shown to be effective. Venous stenosis and thrombosis postpacemaker implantation can occur in up to 35% of patients. This report describes a patient with a preexisting left-sided dual chamber pacemaker and chronic left subclavian vein occlusion that was upgraded to a biventricular system by placing a coronary sinus lead and single chamber ventricular triggered pacemaker on the opposite side.     

Early Complications After Dual Chamber Versus Single Chamber Pacemaker Implantation

This study was performed to compare the frequency of early complications after single chamber versus dual chamber permanent pacemaker implantation. Early complication was defined as one occurring in the 6-week period following implantation. We prospectively analyzed consecutive pacemaker implantation from January 1987 to June 1993 at our regional center. All complications were also analyzed for the relationship to operator experience, the venous access route, and the presence of temporary pacing wire at the time of implantation of the permanent pacing system. A total of 2019 new pacemaker units were implanted during this period. 1733 patients (85.8%) received a VVI pacemaker and 286 (14.2%) a DDD unit. Wound infection occurredin 11 (0.6%) VVI patients and 6 (2.1%) DDD patients. Lead displacement occurred in 18(1 %) VVI patients and 15 (5.2%) DDD patients (11 [3.8%] atrial and 4 [1.4 %] ventricular). There were 10 (0.6%)pneumothoraces, 9 (0.5%) hematomas requiring drainage, 1 (0.06%) chylocele, and 2 (0.1%) deaths in the VVI group. There were 2 (0.7%) pneumothoraces, 2 (0.7%) hematomas, and no deaths in the DDD group. There was no significant increase in complications for experienced infrequent implanters (< 12 systems per year). In both groups the subclavian approach was associated with a risk of pneumothorax when compared to the cephalic approach. The rate of wound infection was higher in patients who had a temporary pacing wire in place. The use of prophylactic antibiotics does not appear to affect the incidence of wound infection. The early complications in the DDD group were higher than in the VVI group (8.7% vs 2.9%, P < 0.05), being mainly due to an increased incidence of wound infection and atrial lead displacement.     

The incidence and risk factors for venous obstruction after implantation of transvenous pacing leads

Several investigators have shown that the incidence of venous obstruction after pacemaker implantation was observed in 31-50% of pacemaker patients. However, these previous reports did not investigate the venous system prior to implantation. The aim of this study was to determine the incidence and risk factors for venous obstruction in patients with transvenous pacing leads. The study included 131 consecutive patients (64 men, 67 women; mean age 71.3 +/- 9.8 years) who were investigated using intravenous digital subtraction angiography (DSA) before and after permanent pacemaker implantation. Follow-up DSA was performed for a mean interval of 44 +/- 6 months after pacemaker lead implantation in 79 of 131 patients. A diameter narrowing > 60% was defined as an obstruction. Prior to implantation of pacing leads, venous obstruction was present in 18 (13.7%) of 131 patients. In 15 of these 18 patients, the obstruction was present at the site of the left innominate vein. Follow-up DSA, after implantation of pacing leads, showed that venous obstruction was observed in 26 (32.9%) of 79 patients. There were no significant differences between obstruction and nonobstruction groups in terms of age, sex, cardiothoracic ratio, left atrial dimension, left ventricular ejection fraction, baseline heart diseases for indication of pacemaker implantation, or number and body size of pacing leads. Neither clinical symptoms nor abnormal physical findings were observed in any patients. In conclusion, the incidence of venous obstruction after pacing lead implantation is less than that of previous reports, which might be related to the incidence of venous obstruction before pacing leads implantation.     

Antibiotic Prophylaxis for Pacemaker Implantation: A Prospective Randomized Trial

Prophylactic antibiotics are frequently prescribed for patients undergoing permanent pacemaker implantation even though data confirming their effectiveness are limited. Five hundred patients requiring elective permanent pacemaker implantation or generator replacement were prospectively randomized either to receive or not receive prophylactic antibiotic treatment at the time of implantation. The implantation site was treated with 10% povidone-iodine solution and 0.5% alcoholic chlorhexidine preoperatively. The wound were inspected for evidence of infection at 3 days and 1, 3, 6 and 12 months postimplantation. Three patients (two receiving prophylactic antibiotics and one no antibiotics) developed pacemaker pocket infection; Staphylococcus aureus was the pathogenic organism in each case (P = 0.56). Eighteen patients developed clinical evidence of superficial wound inflammation requiring antibiotic treatment but not pacemaker removal. Six had received prophylactic antibiotics and 12 had not (P = 0.27). We conclude that pacemaker pocket infection is unusual with careful preoperative skin preparation and close postoperative follow-up. Under these circumstances prophylactic antibiotic treatment is of no practical value.     

246例永久心脏起搏器临床应用体会

对246例患者进行344例次永久起搏器安置术。冠心病Ⅲ房室传导阻滞及病态窦房结综合征是起搏治疗的主要适应症。发生起搏故障52例,其中电池耗竭23例,导管脱位14例,心肌穿孔2例,电极导管折断4例,起搏阀值升高致起搏失灵7例,术后发生局部感染7例,起搏综合征19例,体循环栓塞14例。本文对并发症的防治进行探讨。     

The Retropectoral Transaxillary Permanent Pacemaker: Description of a Technique for Percutaneous Implantation of an "Invisible" Device

This report describes a percutaneous, transaxillary approach for implanting permanent pacemakers in the retropectoral space. This approach was used in 17 patients; indications for the procedure included the need to find a new implantation site in patients with infections and multiple previous pacemaker pocket sites (2 patients), emaciation and absence of sufficient adipose tissue (4 patients), and cosmetic considerations (11 patients). No complications were encountered during the implantation and the results were uniformly excellent in all patients. The pacemaker was "invisible" in each case. We conclude that a percutaneous approach for implanting permanent pacemakers in the retropectoral region is safe and feasible. This approach is likely to be applicable to the implantation of transvenous antitachycardia devices.     

永久性心脏起搏器置入术后囊袋感染原因分析及护理

目的探讨永久性心脏起搏器置入术后发生囊袋感染的相关因素及预防对策。方法对本院2例永久性心脏起搏器置人术后患者囊袋感染原因进行分析,并给予针对性的治疗护理。结果2例患者分别于6个月、9个月起搏器切开处皮肤干性坏死,给予囊袋清除术和重新置人起搏器。结论永久性心脏起搏器置入术后囊袋感染的发生与囊袋大小是否合适、术中操作及患者个体差异有关,应针对原因进行积极治疗和护理,指导患者预防感染。     

永久性心脏起搏器植入术后患者发生深静脉血栓的影响因素分析

目的：探讨永久性心脏起搏器植入术后患者发生深静脉血栓（ DVT）的预测因素及预防性护理措施。方法采用回顾性调查法,查阅2009年1月至2011年12月住院行永久性起搏器植入术的425例患者的住院病历,共发生DVT 32例,对永久性心脏起搏器术后发生DVT的影响因素进行单因素分析与多因素Logistic回归分析。结果单因素方差分析结果表明,年龄、BMI指数、吸烟史、术后制动时间、DVT病史、糖尿病、高血压病、冠心病、房颤、房扑病史为心脏起搏器术后发生 DVT的影响因素（χ2值分别为8．43,5．30,11．86,5．09,17．66,22．36,4．69,12．78,32．52;P＜0．05）。多因素Logistic回归分析结果表明,年龄（OR＝3．463）、肥胖（OR＝3．584）、吸烟史（OR＝2．785）、术后制动时间（OR＝4．844）、DVT病史（OR＝7．605）、各种基础疾病（ OR＝4．052）为永久心脏起搏器植入术后发生DVT 的影响因素（ P均＜0．05）。结论应针对预测影响因素,及时采取护理措施,预防和减少永久性心脏起搏器植入术后DVT的发生。