A case of pacing lead induced clinical superior vena cava syndrome: a case report

INTRODUCTION: Transvenous pacing is a relatively safe treatment with a low complication rate, but serious thromboembolic complications have been reported to occur in 0.6% to 3.5% of cases. Superior vena cava obstruction syndrome is generally an uncommon but serious complication occurring in <0.1% of patients. However, when it occurs it carries with it significant morbidity and mortality. CASE PRESENTATION: A 51-year-old lady with long history of DDD permanent pacemaker presented following a mechanical fall. She had no obvious injuries, and was hemodynamically stable. General examination revealed features suggestive of Superior vena caval obstruction which was later confirmed by imaging. She was treated with long term oral anticoagulation with good clinical improvement. CONCLUSION: Superior vena cava obstruction in patients with transvenous pacing leads, although rare, is a well recognized complication. With growing elderly population and increasing number of procedures performed, more and more people with permanent pacemaker are likely to be encountered in clinical practice. One should carefully look for thromboembolic complications during follow-up in patients with transvenous pacemaker leads, as it has implications for future management and carries significant morbidity and mortality.