title: Outcome and management of pacemaker-induced superior vena cava syndrome.
abstract: BACKGROUND
  We aimed to determine the long-term outcomes of percutaneous lead extraction and stent placement in patients with pacemaker-induced superior vena cava (SVC) syndrome.
  
  
  METHODS
  The study retrospectively screened patients who underwent lead extraction followed by central vein stent implantation at Mayo Clinic (Rochester, MN, USA), from January 2005 to December 2012, to identify the patients with pacemaker-induced SVC syndrome. Demographic, clinical, and follow-up characteristics of those patients were collected from electronic medical records.
  
  
  RESULTS
  Six cases were identified. The mean (standard deviation) age was 56 (15) years (male, 67%). All patients had permanent dual-chamber pacemakers, with a mean 11-year history of pacemaker placement. The entire device system was explanted in five patients; one patient had a 21-year-old pacemaker lead that could not be removed. Eight stents were implanted in six patients: five patients had one stent, one patient had three. A new pacemaker system was reimplanted through the stented vein in five patients. Technical success was achieved in all patients, without any complication. Symptoms rapidly resolved in all patients after stent deployment. The mean follow-up duration was 48 months (range, 10-100 months). Three patients remained symptom free. Reintervention with percutaneous balloon venoplasty was successful in three patients with symptom recurrence.
  
  
  CONCLUSIONS
  Percutaneous stent implantation after lead removal followed by reimplantation of leads is a feasible alternative therapy for pacemaker-induced SVC syndrome, although some cases may require repeat intervention.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Diseases, Henan Provincial People's Hospital, Henan, China.
authors.forename: Hai-Xia
authors.initials: HX
authors.lastname: Fu
authors.forename: Xin-Miao
authors.initials: XM
authors.lastname: Huang
authors.forename: Li
authors.initials: L
authors.lastname: Zhong
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Osborn
authors.forename: Haraldur
authors.initials: H
authors.lastname: Bjarnason
authors.forename: Siva
authors.initials: S
authors.lastname: Mulpuru
authors.forename: Xian-Xian
authors.initials: XX
authors.lastname: Zhao
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: lead extraction; pacemaker; superior vena cava syndrome; venous stenting