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Pacemaker Complication — EECC MCQ

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ModerateCardiac DevicesPacemaker ComplicationEECC

A 58-year-old man with a dual-chamber pacemaker implanted 3 years ago for complete heart block presents with left arm swelling, pain, and dilated superficial veins over the left chest wall. What is the most likely diagnosis and the recommended initial investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Subclavian vein thrombosis; duplex ultrasonography of the upper limb veins

Explanation lettering: C = shown as A · A = shown as C · E = shown as D · D = shown as E

Unilateral arm swelling, pain, and dilated collateral veins on the side of pacemaker implantation is classic for lead-related subclavian/axillary vein thrombosis. Duplex ultrasonography confirms the diagnosis. Lead fracture (B) presents with pacing failure. Pocket infection (C) presents with erythema/discharge at the pocket site. Pneumothorax (D) occurs acutely post-implantation. Pericardial effusion (E) would not cause arm swelling.

Reference: ESC (2021): Guidelines on Cardiac Pacing and Cardiac Resynchronisation Therapy