Venous Occlusions and Anatomic Variants among Patients Undergoing de novo Transvenous Pacing Lead Implantation

Background and Objective: Unexpected venous occlusions or anatomic variants are encountered during de novo transvenous lead implantation. This study examined the prevalence and risk factors of venous abnormalities in patients undergoing de novo permanent pacemaker (PPM) implantation by the transvenous approach. Methods: The study involved 653 consecutive patients who underwent de novo PPM implantation. During the procedure, the venous network of the arms was evaluated using intravenous angiography. Results: Complete venous occlusion was observed in 5 of the 653 patients (0.77%). The lead was implanted on the right opposite site in 4 patients. There were a history of central catheter insertion in four patients, prior thoracic surgery in three, and chemotherapy in two. A persistent left superior vena cava (PLSVC) was observed in 4 patients (0.61%). PPM was implanted from the right opposite side in 2 patients. All PLSVC patients showed normal chest radiographs, but 3 of the 4 patients showed coronary sinus dilatation on echocardiography. Conclusions: Patients requiring transvenous pacing lead implantation rarely exhibit venous abnormalities. However, venous occlusion should be taken into consideration, particularly in patients with a history of insertion of central catheters, thoracic surgery, or chemotherapy. Careful echocardiography test for coronary sinus dilatation must be conducted to detect a PLSVC before the implantation.