Available online 11 September 2020

Heart Rhythm

Background

Superior vena cava (SVC) syndrome includes the clinical sequelae of facial and bilateral upper extremity edema, dizziness, and occasional syncope. Historically, most cases have been associated with malignancy and treatment is palliative. However, cardiac device leads have been identified as important nonmalignant causes of this syndrome. There are little data on the effectiveness of venoplasty and lead extraction in the management of these patients.

Objective

We present our experience in managing 17 patients with lead-induced SVC syndrome. A literature review suggests that this may be the largest case series to date.

Methods

Data collected from January 2003 to July 2019 identified 17 cases of SVC syndrome at our tertiary center. Their outcomes were compared to a control group of patients without SVC syndrome. A P value of <.05 was considered statistically significant.

Results

Of the 17 patients, 13 underwent transvenous lead extraction and venoplasty. Three patients were treated with venoplasty alone, and 1 patient underwent surgical SVC reconstruction. In 10 patients, transvenous reimplantation was necessary. Symptom resolution was achieved in all 17 patients and confirmed at both 6 and 12 months’ follow-up. There was no significant difference in the rate of complications associated with transvenous lead extraction for SVC syndrome vs control.

Conclusion

In patients with SVC syndrome, venoplasty and lead extraction are safe and effective for the resolution of symptoms and maintaining SVC patency.

Keywords

Balloon angioplasty

The cardiac implantable electronic device

Drug-coated balloon

Major complication

Risk factors

Superior vena cava syndrome

SVC stenosis

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