Key result
Inadvertent pacemaker lead placement via collateral veins is linked to vocal cord paralysis and tracheostomy.
Case Report
Careful procedural monitoring during pacemaker implantation is crucial to avoid atypical lead pathways that can result in severe complications like vocal cord paralysis.
Alerts to rare lead malposition risks during implantation; leaves open whether enhanced imaging prevents such complications.
The axillary and cephalic veins are commonly utilized for transvenous pacemaker lead access. They typically advance to the heart through the subclavian, brachiocephalic, and superior vena cava veins. Anatomical variations such as a persistent left superior vena cava (PLSVC) may pose a challenge, necessitating an alternative approach for lead placement. This anomaly can often be identified during venographic contrast imaging or by visualizing atypical venous courses during the procedure. Another challenge occurs when the venous pathway is tortuous. Careful monitoring during the procedure is crucial to ensure that the lead follows the intended path. If not, the lead may inadvertently enter a collateral, such as the inferior thyroid vein, which drains into the internal jugular or left brachiocephalic vein. Despite these deviations, the lead may eventually reach the heart, although via an unusual course. If such a lead is left in place, even in the absence of immediate complications, long-term outcomes are unpredictable and carry the risk of unforeseen complications.
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Jagielski et al. (2025) conducted a case report in Pacemaker implantation complications. Transvenous pacemaker lead placement was evaluated. Inadvertent pacemaker lead placement through a collateral vein can lead to unpredictable long-term outcomes, including vocal cord paralysis and tracheostomy.
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