Inferior vena cava obstruction secondary to permanent pacing

A 74-year-old man presented with severe swelling of the abdomen, and legs 22 years after pacemaker implantation. Contrast CT and an intra-venous cavogram showed occlusion of the inferior vena cava (IVC) from the level of the left renal vein to the liver. He died 26 days after admission, of a low output state. Post mortem examination revealed two pacing wires deeply embedded in fibrous tissue in the right atrium, causing moderate stenosis of the superior vena caval orifice into the right atrium and very severe stenosis of the inferior vena caval orifice down to 4 mm. We believe that this unique case was due to an ideopathic reaction to a cut pacing lead and an exaggerated loop in the second lead.