ArticleEuropean heart journal. Case reports2026
Superior vena cava perforation during atrial lead implantation in a patient with repaired tetralogy of Fallot: a case report.
Article in European heart journal. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Superior vena cava (SVC) injury during pacemaker implantation is rare, with most cases reported during lead extraction rather than placement. In adults with congenital heart disease (ACHD), unexpected resistance during lead advancement requires immediate reassessment because technical or device-related factors can cause venous injury even when pre-procedural imaging does not show hostile venous anatomy. Evidence on the management of venous injury during implantation is limited. Case presentation: A 62-year-old woman with repaired tetralogy of fallot (TOF) presented with recurrent syncope. An implantable loop recorder documented a 10-s sinus pause. She underwent elective dual-chamber pacemaker implantation. Left subclavian venous access was obtained, and the right ventricular lead was positioned without difficulty. During advancement of the atrial lead, resistance was encountered at the subclavian-SVC junction, and the lead was withdrawn. Intraprocedural venography demonstrated focal contrast pooling at the SVC-azygos junction with mediastinal extravasation, concerning for SVC dissection or contained perforation. The patient remained haemodynamically stable. Transthoracic echocardiography showed no pericardial effusion. Non-contrast computed tomography of the chest confirmed mediastinal contrast adjacent to a patent SVC without obstruction or thrombosis. Conservative management with close observation was undertaken. Repeat CT imaging after 24 h demonstrated complete resolution. Inspection of the atrial lead revealed unintended extension of the active-fixation screw, suggesting a mechanical mechanism for venous injury. Discussion: This case highlights a rare but important complication of pacemaker implantation in ACHD. The normal pre-procedural venous assessment, uncomplicated right ventricular lead placement, and unintended extension of the atrial lead fixation screw support a device-related mechanical mechanism rather than anatomical difficulty. It emphasizes immediate cessation of advancement when resistance occurs, lead inspection with confirmation of screw retraction, early venography, and conservative management in haemodynamically stable patients with a patent SVC.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.