Superior vena cava syndrome due to pacemaker leads: an Indian report with a review of management practices

Superior vena cava [SVC] syndrome due to pacemaker leads is a distinct diagnostic rarity. It is diagnosed clinically based on constellation of signs and symptoms supported by imaging evidence of SVC obstruction. A 70-year-old male, an ex-smoker, presented with facial and upper limb swelling along with exertional dyspnea. He had undergone transvenous dual chamber rate modulated [DDDR] pacemaker implantation four years back for symptomatic sinus node dysfunction. Imaging demonstrated a hypodense-filling defect in the SVC causing 70-80% luminal narrowing along with presence of collaterals. Patient was managed on anticoagulants and planned for SVC stenting with epicardial pacing which failed. Patient refused to undergo further any further treatment and was subsequently lost to follow-up. To the best of our knowledge, this is the first detailed description of SVC syndrome due to pacemaker leads from India, which was managed medically.