title: Bi-atrial subxiphoid epicardial pacemaker in superior vena cava syndrome.
abstract: A patient with a bi-atrial-ventricular permanent pacemaker due to paroxystic atrial fibrillation associated to sinus bradycardia, in chronic use of oral anticoagulant, presented clinical signs of superior vena cava syndrome. Digital subtraction venography showed total obstruction of the right brachiocephalic venous trunk and severe stenosis of the connection of the left trunk to the superior vena cava. The therapeutic approach consisted of complete removal of transvenous system followed by re-implant of the bi-atrial-ventricular system using an epicardial subxiphoid access with fluoroscopic assistance.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, FM, USP, São Paulo, SP, Brazil. rcosta@cardiol.br
authors.forename: Roberto
authors.initials: R
authors.lastname: Costa
authors.forename: Maria Inês de Paula
authors.initials: MI
authors.lastname: Leão
authors.forename: Kátia Regina da
authors.initials: KR
authors.lastname: Silva
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: Camargo
authors.forename: Regina Valéria
authors.initials: RV
authors.lastname: Costa
mesh_terms: D000368:Aged; D020878:Device Removal / Q000379:methods; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010496:Pericardium; D012086:Reoperation; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy