Key result
The 'inside-out' technique provides an alternative approach to allow conduction system pacing in patients with superior vena cava obstruction.
Why the study?
Chronic venous occlusion complicates cardiac device implantation or upgrade, and existing alternatives like venoplasty or contralateral implantation have variable success or are precluded by bilateral or SVC occlusion.
Describes the "inside-out" technique as a potential solution for achieving conduction system pacing in patients with superior vena cava obstruction.
May inform technique selection in venous occlusion cases; leaves open optimal strategy pending comparative data.
Chronic venous occlusion is an increasingly common problem faced during transvenous cardiac device implantation or upgrade. This is attributable to the growing number of pacemakers implanted and subsequent need for an upgrade to a complex system (e.g. biventricular pacing, conduction system pacing, implantable cardiac defibrillator). Venoplasty, with or without stenting, and lead implantation on the contralateral side with tunnelling across to the current device site are alternatives. However, venoplasty has variable success rates, and lead implantation on the contralateral side is possible only in the absence of bilateral central venous occlusion or superior vena cava (SVC) occlusion.
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Liew et al. (2024) studied Superior vena cava obstruction / chronic venous occlusion. Inside-out technique was evaluated. The 'inside-out' technique provides an alternative approach to allow conduction system pacing in patients with superior vena cava obstruction.
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