Pacemaker induced superior vena cava syndrome: a case report

INTRODUCTION: Pacemaker induced superior vena cava syndrome is an unusual complication of pacemaker implantation. Endothelial damage caused by repeated trauma from the lead is thought to be responsible for the stenosis. Malignancy has been historically the most common etiology. However, the increase in use of indwelling venous catheters and cardiac pacemaker has resulted in more patients with superior vena cava syndrome of benign etiology. CASE PRESENTATION: A 54-year-old female presented with recurrent spasm and swelling of the neck for the duration of two months. Pacemaker was implanted in 1997 for symptomatic third degree heart block. It was removed in 2007 due to recurrent infection at the lead site. Computed tomography of the chest and venogram were performed which showed stenosis at origin of the superior vena cava with some collateral circulation. She underwent angioplasty by the interventional radiology and is currently free of symptoms. CONCLUSIONS: Our case highlights a relatively uncommon complication of pacemaker. As a primary care physician, one should be aware of this unusual complication of pacemaker. Superior vena cava syndrome should be suspected in patients with history of pacemaker insertion who present to the primary care physician with neck spasm or neck swelling. Primary care physicians should also be aware balloon angioplasty is a reasonable primary intervention in selected patient population.