Published online Dec 16, 2023. doi: 10.12998/wjcc.v11.i35.8364
Peer-review started: August 30, 2023
First decision: October 10, 2023
Revised: October 21, 2023
Accepted: December 4, 2023
Article in press: December 4, 2023
Published online: December 16, 2023
Processing time: 105 Days and 6.2 Hours
Although superior vena cava (SVC) syndrome has also been reported as a late complication of pacemaker (PM) implantation, acute onset of SVC syndrome caused by disdialysis syndrome in patients with PM implantation is very rare. There are no specific therapies or guidelines.
A 96-year-old woman receiving dialysis was implanted with a PM due to sick sinus syndrome. She was referred to our facility for chest discomfort experienced during dialysis. Upon examination, unilateral pleural effusion on the right side was cloudy with a foul odour. The patient was diagnosed with pyothorax and treated with antibiotics. After the effusion was reduced, it gradually reaggravated and remained cloudy. In this case, SVC syndrome, which is generally considered a late complication after PM implantation, rapidly developed following the bacteraemia, resulting in impaired venous return, chylothorax, and disdialysis syndrome. After catheter intervention for SVC stenosis, the patient’s symptoms promptly improved. The patient has been recurrence-free for a year.
Acute SVC syndrome can cause dysdialysis in PM-implanted patients. Catheter intervention alone has improved this condition for a traceable period.
Core Tip: While superior vena cava (SVC) syndrome has also been reported as a late complication after pacemaker (PM) implantation, our case is novel because, to the best of our knowledge, no instances of ‘acute’ SVC syndrome resulting in disdialysis in a patient on maintenance haemodialysis after PM implantation has been reported. We wish to emphasize the following key points: (1) Acute-onset SVC syndrome should be considered when acute disdialysis is encountered in patients with a PM on dialysis; and (2) the efficacy of treatment using percutaneous old balloon angioplasty alone, which has demonstrated long-term effectiveness.