# Literature Review of Venous Spasm During Pacemaker Implantation

## TL;DR

This review summarizes venous spasm during pacemaker implantation, its features, and management strategies based on existing literature.

## Contribution

The paper proposes a stepwise workflow for managing venous spasm and highlights the need for standardized treatment guidelines.

## Key findings

- Venous spasm is more common in older female patients and often occurs in the axillary and subclavian veins.
- Contrast venography is typically used to diagnose spasm after failed guidewire passage.
- Management strategies include nitroglycerin, hydrophilic guidewires, and procedural adjustments.

## Abstract

Venous spasm is a rare yet clinically relevant complication during pacemaker implantation that can obstruct venous access and delay procedures. Despite its significance, it is infrequently reported in the literature and not clearly understood, thus lacking a standardized management protocol. This review aimed to synthesize current literature on venous spasm occurring during pacemaker or any other cardiac device implantation, highlight common features, and summarize effective management strategies. A comprehensive search of PubMed, Embase, and ScienceDirect through July 2025 identified 17 relevant sources, including five studies and 12 case reports. Axillary and subclavian venous spasm was most frequently reported, particularly in older female patients, and typically diagnosed by contrast venography following unsuccessful guidewire passage. Cephalic venous spasm was also noted infrequently. Management strategies varied, with reported interventions including temporary cessation of manipulation, use of hydrophilic guidewires, administration of intravenous nitroglycerin, adjustment of access puncture site, or contralateral venous access. In some cases, venous spasm was refractory to treatment, requiring procedural modification or abandonment. This review consolidates previously used successful management strategies into a proposed stepwise workflow and underscores the need for further research to improve understanding of venous spasm and to develop standardized treatment guidelines.