Zheng Zhi-Peng, Zhang Wei, Zeng Zhi-Huan, Zheng Jian-Yi
Department of Cardiovascular, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China.
J Int Med Res. 2021 Jan;49(1):300060520945170. doi: 10.1177/0300060520945170.
Cardiac implantable devices are commonly used for superior vena cava stenosis, but there have been few reports of electrode replacement in the stenosed superior vena cava. A 73-year-old man was diagnosed with second-degree type II atrioventricular block and a permanent dual-chamber, rate-modulated pacing pacemaker was implanted 10 years previously. Because of depletion of the pacemaker battery and an increase in the ventricular pacing threshold, replacement of the pacemaker and ventricular electrode was required. During the operation, we found that the patient had severe superior vena cava stenosis on angiography, and this caused obstruction when a common guidewire was used to pass through the superior vena cava. After attempting various methods, we successfully passed through the vascular stenosis with a super slide guidewire and a long sheath, and completed replacement of the pacemaker and ventricular electrode. We summarize the related literature of superior vena cava stenosis related to a cardiac implantable device, and discuss the replacement strategy of this complication and other treatment options.
心脏植入式设备常用于上腔静脉狭窄，但关于在狭窄的上腔静脉中更换电极的报道很少。一名73岁男性被诊断为二度II型房室传导阻滞，10年前植入了永久性双腔、频率适应性起搏起搏器。由于起搏器电池耗尽和心室起搏阈值升高，需要更换起搏器和心室电极。手术过程中，我们在血管造影时发现患者存在严重的上腔静脉狭窄，使用普通导丝穿过上腔静脉时造成了阻塞。尝试了各种方法后，我们使用超滑导丝和长鞘成功穿过血管狭窄部位，并完成了起搏器和心室电极的更换。我们总结了与心脏植入式设备相关的上腔静脉狭窄的相关文献，并讨论了这种并发症的更换策略及其他治疗选择。
