Subclavian DVT - One Year Later

I've been a ski instructor/guide for years, but only worked one winter since my implant joined me last year. For me i've always had more lower than upper body mass, but as COVID struck I saw the opportunity to change that with some easy 5min/day routines and took up surfing.

A month down the line, my left arm started to swell, which I initially mistook for rapid 'gains'. But it turns out that I developed a massive blood clot in my subclavian vein. So far the haemotologist has implied it is unlikely to be due to PM since it occured a year after insertion. However, I find the coincidence to be uncanny due to the proximity of the vein to my device. Especially since I only recently began using/develping muscle mass in the area. Has anyone had anything similar?

A further complication is I was supposed to get an 'upgrade' to a His-Bundle pacing device with a fresh new lead, which is now being pushed back. (/vent)


4 Comments

Where were your leads run?

by CyborgMike - 2020-06-17 21:43:01

When I got my PM the way it was explained to me is that one of my major veins from the left arm was cut in my shoulder, the arm side clamped and the heart side was used to run my leads into the heart. So, my arm swelled during the 4-5 weeks of healing (normal) as my body rebuilt the return capcity in the other veins. More blood capacity going in than coming out equals swelling.

So, it seems reasonable that if your leads were run in your subclavian vein then a clot could form and/or if the leads are run through a vein that empties to your subclavian. Did the haemotologist indicate the relationship between the leads vein and the clot vein?

Also... I hate to raise this question, but any chance you have been exposed to Covid? There are a LOT of strange clotting issues related to Covid even in asymptomatic people.

Subclavian vein blockage

by Gemita - 2020-06-18 03:25:00

Dear Cybork,

I am so sorry to hear of your problems.

I tend to agree with your thinking that this may well be due to your pacemaker implant, even one year on.  Blockages, narrowings where leads reside can often go undiagnosed for months or even years as our bodies develop collateral veins to by pass the blockage and many of us therefore remain completely asymptomatic.  It has happened to me and I am two years on from my implant.  

I was told venous complications due to pacemaker leads are very common following pacemaker implant and can lead to stenosis, occlusions, and superior vena cava syndrome.  I have not experienced any "significant" swelling although there is clearly some but I do have intermittent collarbone and left armpit pain.  I also have clear signs of collateral vein formation around my pacemaker site.  

I am keeping an eye on this although with COVID-19 still around my doctors are reluctant to bring me into hospital for further imaging right now.  In any event I am on anticoagulation for another condition, so I am hoping this will keep my blood flowing and keep me out of trouble.

Perhaps you have unmasked this problem through your upper body strengthening exercises?  Did they tell you how they plan to treat your DVT?   Yes any venous obstruction can complicate system revision or make an upgrade more difficult.  I really hope they can still do your HIS bundle upgrade and that it will be successful.  Good luck

Sounds good that they are taking this seriously

by crustyg - 2020-06-18 03:54:41

There are a number of rare clotting disorders that can manifest with an additional risk factor (e.g. leads in a large vein), and it's good that your haematologist is not taking the easy/lazy approach of just blaming the PM leads.  Once they've searched carefully for these conditions, *then* is the time to blame the leads.  And hopefully shift you to His-bundle pacing.

You are correct that a lot of rubbing against the inside of a vein can damage the internal layer which can trigger a clot.  Whether this makes you liable to recurrent clots is a difficult one.

Let them do a proper work-up, then you'll know: it may be that you can have the His-bundle lead and then go onto a modern oral anti-coagulant and get on with your surfing - it's a rush the first time you stand up on the board and actually surf, isn't it?  And life's for living.

Virus

by Dave H - 2020-06-18 11:19:51

Sounds like you're being well cared for.......you haven't mentioned where your EP is in all of this. BTW: I'll be in the hosp. in a few days for a epicardial lead implant.  I'm not too concerned about the virus while in the hospital ---- one does not get in the door without a mask, and the current reasoning is transmission comes from breathing particles, which the general population is too ignorant to understand.  The mask protects you from me - not me from you.

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