Successful upgrade to cardiac resynchronization therapy for cardiac implantation-associated left subclavian vein occlusion: A case report

Abstract

Background: Subclavian vein stenosis or occlusion may be caused by a transvenous pacemaker, which makes the reimplantation of a new pacemaker lead difficult. Transvenous pacemaker lead implantation-related subclavian vein occlusion may present difficulty with regard to cardiac resynchronization therapy (CRT) upgrade.

Case summary: We report the case of a 46-year-old man who was admitted with total subclavian vein occlusion caused by a permanent pacemaker that had been implanted 2 years previously. We successfully treated this patient with an upgrade to a CRT pacemaker by utilizing transferable interventional coronary and radiological techniques. The patient recovered uneventfully during the follow-up period.

Conclusion: CRT upgrade is still a viable technique for the treatment of subclavian vein obstruction caused by previous pacemaker implantation.

Keywords: Cardiac resynchronization; Case report; Pacemaker; Radiological techniques; Subclavian vein obstruction; Therapy; Venoplasty.

Figure 1

Venogram showing complete occlusion of the left subclavian vein.

Figure 2

Cardiac resynchronization therapy pacemaker procedure. A: Proximally cut lead portions and a Radifocus guidewire tip were fixed with a suture, and the rest of the wire was covered by a Finecross catheter; B: The atrial lead tip captured in a goose-neck snare was positioned in the right atrium; C: The atrial lead was placed in the 8 French femoral vein sheath and removed from the right femoral vein; D: The balloon was dilated across the occlusion in the left subclavian vein; E and F: Intra-procedure fluoroscopy showed the location of the lead of the cardiac resynchronization therapy pacemaker.