A challenging image during pacemaker implantation
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ABSTRACT:
SUBMITTER: Koza Y
PROVIDER: S-EPMC5336930 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC5336906 | biostudies-literature
Project description:BackgroundSubclavian venous spasm is an uncommon complication during permanent pacemaker implantation. The exact aetiology of subclavian venous spasm is not clear but has been suggested to be due to either mechanical irritation of the vein during needle puncture or due to chemical irritation from contrast injection. Here, we report a case of an unyielding subclavian vein valve that impeded guidewire advancement and the repeated guidewire manipulation led to venous spasm.Case summaryA 45-year-old woman with a history of surgical repair of Tetrology of Fallot in childhood presented with symptomatic bifascicular block and underwent a permanent pacemaker implantation. A subclavian venogram done prior to the procedure showed a prominent valve in the distal portion of the vein. Following venous puncture, guidewire advancement was impeded by the prominent valve. The resulting guidewire manipulation led to subclavian venous spasm necessitating a medial subclavian venous puncture and access.DiscussionProlonged mechanical irritation of the vein during pacemaker implantation may lead to venous spasm impeding pacemaker implantation. Early identification of an impeding valve and obtaining access medial to the valve may help prevent this uncommon complication.
| S-EPMC7528504 | biostudies-literature
Project description:Key clinical messageVenous spasm is an important reason for complicated or failed implantations of cardiac implantable electronic devices. Prevention or risk reduction of venous spasm during cardiac implantable electronic device implantation may be achieved by ultrasound or fluoroscopic imaging prior to puncture, cephalic vein cut-down, sufficient pre- and perioperative hydration, nitroglycerin injection and effective sedation, and analgesia.AbstractThis case report with literature review focuses on venous spasm as a potential cause for complicated implantations of cardiac implantable electronic devices. The case report is clinically relevant as it describes a progressive spasm affecting the axillary and the subclavian vein. A 66-year-old female complained of symptomatic atrial fibrillation (AF) and atypical atrial flutter despite interventional and medical treatment. As an ultimate treatment, she was scheduled for pacemaker implantation and atrioventricular node ablation. Several puncture attempts of the axillary vein failed. Despite venous blood aspiration, no guidewires could be advanced into the axillary vein. We performed a first venogram revealing significant spasm of the axillary vein. Another failed venous puncture occurred after change of access site to the subclavian vein. A second venogram displayed progression of the spasm, now affecting both the axillary and the subclavian veins. Normal saline perfusion was administered as well as intravenous isosorbide. Unfortunately, a repeated venogram after 15 min waiting time showed persistence of the spasm, still affecting both veins. The procedure was discontinued as the patient became uncomfortable. Venous spasm is an important reason for complicated or failed implantations of cardiac implantable electronic devices. Commonly used medical prevention and treatment are intravenous fluids and nitroglycerin. Prevention or risk reduction of venous spasm during cardiac implantable electronic device implantation may be achieved by ultrasound or fluoroscopic imaging prior to puncture, cephalic vein cut-down, sufficient pre- and perioperative hydration, nitroglycerin injection and effective sedation and analgesia.
| S-EPMC11319219 | biostudies-literature
Project description:Leadless pacemaker implantation is recognized as safe and effective for treating bradycardia. However, there are limited descriptions of its use in patients with complex anatomical considerations. Here, we present a case detailing the successful implantation of a leadless pacemaker with a tortuous inferior vena cava and a narrow right atrium.
| S-EPMC10963639 | biostudies-literature
Project description:Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.
| S-EPMC8811277 | biostudies-literature
Project description: Not available
| S-EPMC8695296 | biostudies-literature
Project description:We report a case of pulmonary embolism while performing pacemaker implantation in an obese patient and its management as well as certain precautions that one must consider in an obese patient especially under conscious sedation. Air embolism during pacemaker implantation although rare can be life-threatening in certain conditions such as massive pulmonary embolism. Air embolism during this procedure mainly occurs through open sheath just before inserting the lead. Certain risk factors associated with this condition include deep inspiration, frequent coughing, advanced age, sheath with larger diameter, and sedatives. Obesity along with associated factors including sleep apnea, restrictive lung disease, and challenges during airway management can create troubles during pacemaker implantation. Conscious sedation is usually required when a patient becomes restless during the procedure either due to pain or prolonged supine position. At times a patient can transiently go into the deep sedation and a deep inspiration during this phase can be detrimental in a procedure where it is undesirable and adds to the risk of air embolism. Here we discuss the management and alternative methods which can be used to avoid such complications. <Learning objective: Pacemaker implantation procedure can be performed with minimal sedation instead of conscious sedation. Although conscious sedation seems more suitable, it carries the risk of complications such as air embolism that can be precipitated by involuntary deep inspiration during the procedure. When conscious sedation is required one must reconsider the need as well as alternatives so as to avoid such complications.>.
| S-EPMC7718507 | biostudies-literature
Project description: Not available
| S-EPMC11312032 | biostudies-literature
Project description: Not available
| S-EPMC5643851 | biostudies-literature
Project description:Iatrogenic arteriovenous fistula is a unique complication during pacemaker implantation. A 55-year-old man was posted for pacemaker implantation for recurrent unexplained syncope with trifascicular AV block. After axillary/subclavian venous puncture and introduction of RV lead, arterial spurting was immediately noticed as the the sheath was peeled away. After dissecting the overlying pectoralis muscle, deep sutures and manual compression achieved hemostasis. However, Subclavian arteriogram revealed an arteriovenous fistula from a lateral thoracic artery branch to the innominate vein. Hilal coils were deployed near the fistulous orifice, leading to complete resolution of the leak. After 3 days, pacemaker was implanted from right side. A multidisciplinary approach was the key to successful outcome.
| S-EPMC6010009 | biostudies-literature