Association between selected risk factors and the incidence of venous obstruction after pacemaker implantation: demographic and clinical factors

Abstract

Background: Venous obstruction and subsequent pulmonary embolism belong to the most common and dangerous complications of pacemaker implantation. Thus, identification of patients at risk of venous obstruction seems to be of critical importance.

Aim: To determine risk factors of venous obstruction following pacemaker implantation.

Methods: Eighty one patients with permanent cardiac pacing (31 F, 50 M; mean age 71.1 ± 7.6 years) were included. Prior to pacemaker implantation, the following factors were evaluated in each patient: indications for pacemaker implantation, heart failure severity assessed using the NYHA classification, coexisting diseases, a history of tobacco smoking, medications used before the procedure (antiplatelet drugs, anticoagulants, antibiotics), a history of thrombotic or infectious complications, and previous temporary cardiac pacing. Type of venous access and procedure time were also assessed. Venous ultrasound examination to evaluate veins in both upper extremities, shoulder areas and the neck was performed before pacemaker implantation and 6 and 12 months following the procedure. Computed tomography and conventional digital subtraction angiography were performed to confirm the diagnosis of venous obstruction.

Results: The patients were divided into two groups based on the occurrence of venous obstruction after pacemaker implantation. Group I (n = 71, 29 F, 42 M; mean age 71.0 ± 7.7 years) included patients without venous obstruction, and group II (n = 10, 2 F, 8 M; mean age 71.6 ± 7.0 years) included patients diagnosed with venous obstruction. Each patient was followed for 19 months. In group II (12.3% of the study population), venous obstruction developed mean 13 months after pacemaker implantation. In this group, symptomatic venous obstruction was observed in 3 patients (3.7% of the study population), mean 15 months after pacemaker implantation. Risk factors for venous obstruction included a history of myocardial infarction, temporary cardiac pacing, arrhythmia, venous anomalies, NYHA class III and IV heart failure, a history of infection, and tobacco smoking. Depending on the number of risk factors, the probability of development of venous obstruction was described by the following equation: e(-14.6 + 3.19x)/1 + e(-14.6 + 3.19x), where x is the number of risk factors. In patients who had more than 6 risk factors, almost a 100% probability of the occurrence of venous obstruction was observed.

Conclusions: 1. Risk factors for venous obstruction include a history of myocardial infarction, temporary cardiac pacing, arrhythmia, venous anomalies, infections, NYHA class III and IV heart failure, and tobacco smoking. 2. In patients who had more than 6 risk factors, almost a 100% risk of venous obstruction was observed.