Pacemaker-induced Superior Vena Cava Syndrome : Report of One Case and Review of the Literature

A 76-year-old man developed superior vena cava syndrome (SVCS) 20 months after the implantation of a dual chamber pacemaker, and was successfully treated with thrombolytic therapy followed by long-term anticoagulant therapy. The face and neck were markedly swollen, and superficial veins in the neck, upper arms and upper chest were prominently distended. Venography from bilateral cubital veins revealed a severe stenosis of the distal segment of the superior vena cava without the development of collateral channels. After an initial treatment with urokinase for 5 days followed by warfarin for 16 months, the symptoms and signs of the SVCS disappeared, and the digital subtraction angiography revealed a marked regression of the thrombotic stenosis. In view of the expected increase in the insertion of multiple leads in cases of dual chamber pacemakers or including fractured lead retention, more attention should be paid to the risk of the development of the SVCS in these cases