Incidence and Risk Factors of Subclavian Vein Stenosis after Permanent Transvenous Pacemaker in Pediatric Population

Background: Subclavian venous (SCV) stenosis due to a permanent transvenous pacemaker has been described as the most common complication associated with this procedure however, the incidence and risk factors of venous obstruction and occlusion due to endocardial leads in a small group of infants and young children were not fully assessed.
Objective: The aim of the current work was to evaluate the incidence and degree of subclavian stenosis and risk factors for stenosis in the pediatric population after transvenous pacemaker insertion.
Patients and Methods: This is a cross-sectional study conducted on children who had transvenous pacing leads implanted between 2010 and 2018 at the cardiology clinic of Cairo university children's Hospital with pre-implantation subclavian venography and evaluated after the duration of implantation ranged from 1-5 years. Subclavian venography was done to all patients.
Results: The incidence of mild to moderate stenosis in cases at time of assessment was 88.3 % of the cases, while the incidence of severe angiographic stenosis was only 11.7 % of cases with development of venous collaterals in patients of severe stenosis. Risk of subclavian stenosis increased with lower weight at time of implantation.
Conclusion: It could be concluded thatsubclavian vein stenosis is a common complication after transvenous pacemaker insertion in the pediatric population, but it occurs at mild to moderate degrees, while severe stenosis is rare, usually asymptomatic, and subclinical and correlated with the weight of the patient at the time of implantation of pacemaker. So, transvenous pacing in children can be done safely with favorable results and minor complications.