Joint Pacing and Vascular Intervention for the Management of Cardiac Device Associated Central Venous Obstruction.

IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-09-01 Epub Date: 2025-07-31 DOI:10.1111/pace.70019
Nadeev Wijesuriya, Helen Sinabulya, Helena Johann-Meyer, Keisha Kellman, Felicity de Vere, Sandra Howell, Alphonsus Liew, Paolo Bosco, Steven A Niederer, Stephen Black, Christopher A Rinaldi
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Abstract

Background and aims: Central venous obstruction (CVO) increases the complexity of pacing interventions, whether it be with device-associated symptomatic superior vena cava syndrome (SVCS), or by impeding new implants. Endovascular treatment involves the joint expertise of both cardiac pacing and vascular specialists. We report the outcomes of such procedures at our institution.

Methods: A single-center retrospective observational study, examining outcomes of joint pacing-vascular procedures for CVO. Cases were screened from an existing institutional database.

Results: There were 19 total cases. Two were new device implants where the novel "inside-out" procedure was utilized to establish access in SVCS, both with no complications. The remainder (n = 17) were transvenous lead extractions plus attempted recanalization of CVO using venoplasty with or without stenting. Transvenous devices were re-implanted in eight patients. Complete procedure success rate was 84%. There were two cases of pericardial effusion requiring pericardiocentesis, resulting in procedure abandonment. There was no in-hospital mortality and no cases of emergency sternotomy. Over mean follow-up of 28 months, 2/6 patients receiving venoplasty (33%) and 2/8 patients receiving stenting (25%) required re-intervention for symptomatic restenosis. Of the patients who were not re-implanted with a transvenous device following initially successful endovascular intervention (6/14), none had recurrence over the follow-up period.

Conclusion: Pacing interventions in SVCS carry a significant risk profile, requiring management by experienced operators in high-volume centers to maximize safety. Endovascular interventions have a significant recurrence rate, with up-front stenting potentially being superior. Our data suggests that those without re-implantation of transvenous leads may have better long term outcomes.

Abstract Image

Abstract Image

联合起搏和血管介入治疗心脏装置相关中心静脉阻塞。
背景和目的:中心静脉阻塞(CVO)增加了起搏干预的复杂性,无论是与器械相关的症状性上腔静脉综合征(SVCS),还是阻碍新的植入物。血管内治疗涉及心脏起搏和血管专家的联合专业知识。我们在本机构报告此类程序的结果。方法:单中心回顾性观察研究,检查CVO联合起搏血管手术的结果。从现有的机构数据库中筛选病例。结果:共19例。其中两种是新的器械植入物,采用新颖的“由内而外”的方法来建立SVCS的通路,均无并发症。其余的(n = 17)是经静脉铅拔出加上使用静脉成形术(有或没有支架)对CVO进行再通。8例患者再次植入经静脉装置。手术成功率为84%。有两例心包积液需要心包穿刺,导致手术放弃。无院内死亡病例,无紧急胸骨切开术病例。在平均28个月的随访中,2/6接受静脉成形术的患者(33%)和2/8接受支架植入术的患者(25%)因症状性再狭窄需要再次干预。在最初成功的血管内干预后没有再次植入经静脉装置的患者中(6/14),在随访期间没有复发。结论:SVCS起搏干预具有显著的风险,需要在大容量中心由经验丰富的操作人员进行管理,以最大限度地提高安全性。血管内介入有显著的复发率,正面支架置入可能是更好的选择。我们的数据表明,不重新植入经静脉导联的患者可能有更好的长期预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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