An alternative approach for endocardial pacemaker lead implantation in patient with persistent left superior vena cava

Mitov, Vladimir; Perišić, Zoran; Kostić, Tomislav; Stojković, Aleksandar; Jolić, Aleksandar; Aleksić, Aleksandar; Milašinović, Goran

doi:10.2298/sarh1002085m

Cited by 5 publications

(4 citation statements)

References 7 publications

(6 reference statements)

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“…Abutting the lead on the free wall of RA gave a better support so that the lead could be pushed across the tricuspid valve. There are reports of using long 40-cm worley sheath for better support for RV lead placement [14]. Also venous sheath can be left while manipulating the lead to enter the right ventricle.…”

Section: Discussionmentioning

confidence: 99%

Permanent Pacemaker Implantation in Patients With Isolated Persistent Left Superior Vena Cava From a Right-Sided Approach: Technical Considerations and Follow-Up Outcome

et al. 2019

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Background Positioning a permanent pacing wire in patients with persistent left superior vena cava (PLSVC) to right ventricle often comes as on-table surprise. It is technically demanding and therefore most of operators prefer left-sided approach. We assessed technical challenges during pacemaker implantation, and their short- and long-term outcomes among patients with isolated PLSVC from a right-sided approach. Methods Thirty-one consecutive patients with isolated PLSVC and 93 patients with right superior vena cava (RSVC) were enrolled with syncope with sinus node dysfunction (SND) and atrioventricular (AV) block. Study was designed on the basis of nested case-control method, and therefore 1:3 proportions was the enrolment criteria to detect any difference as statistically significant as incidence of isolated PLSVC is low. Results Mean age of patients was 64.8 ± 10.5 years. SND was the most common indication (n = 55; 44%) followed by AV block (n = 47; 37%). Nineteen (20%) patients received tined pacing lead, while 105 (85%) had screwing lead. There was no significant difference in mean procedural time (25 ± 11 min vs. 23 ± 12 min; P = 0.24), mean fluoroscopic time (3.1 ± 2.2 min vs. 2.7 ± 2.1 min; P = 0.54), pacing parameters for atrial and ventricular leads, dislodgement rate (3.2% vs. 4.8%; P = 0.32) and follow-up duration (6.9 ± 1.3 years vs. 7.2 ± 1.1 years; P = 0.18) between two groups. Compared to patients with RSVC, those with PLSVC had alpha loop configuration for ventricular lead which was statistically significant (31 vs. 00; P = 0.002). Conclusions Patients with PLSVC had alpha loop configuration for ventricular lead because of circuitous course via left mediastinum. Although pacemaker implantation through coronary sinus via isolated PLSVC from right sided-approach is technically challenging, it obtains good long-term results but needs frequent follow-up during the initial period.

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Section: Discussionmentioning

confidence: 99%

Permanent Pacemaker Implantation in Patients With Isolated Persistent Left Superior Vena Cava From a Right-Sided Approach: Technical Considerations and Follow-Up Outcome

et al. 2019

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“…Once the lead was in RV, took out the straight stylet, and screwed it at RV apex. Other methods which can be applied are implantation through IVC route, epicardial pacing, or leadless pacemaker implantation [14,15]. PPI in case of PLSVC CONCLUSION Implantation of the pacemaker in the presence of persistent LSVC is technically demanding and needs patience but can be done successfully with proper techniques.…”

Section: Discussionmentioning

confidence: 99%

A Case of Permanent Pacemaker Implantation From the Left Side in Persistent Left Superior Vena Cava – Technical Challenges in a Rare Presentation

Sharma¹,

Prakash²,

Sarraf³

2020

IJCR

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“…There are reports of using long 40 cm worley sheath for better support for RV lead placement. [ 5 ] Surgical epicardial lead placement is an option where the endocardial RV lead positioning gets extremely difficult because of unfavorable venous anatomy. [ 6 ] Regarding the atrial lead placement, active fixation lead in the right atrial anterior free wall is preferred.…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 ] Regarding the atrial lead placement, active fixation lead in the right atrial anterior free wall is preferred. [ 5 ] But passive fixation lead can be positioned into the atrial appendage. [ 7 ] In our case we used a 58 cm active fixation lead into the atrial appendage with acceptable parameters.…”

Section: Discussionmentioning

confidence: 99%

Beware of venous anomalies in young patients with sick sinus syndrome: A report of two cases of sick sinus syndrome with systemic venous anomalies

2015

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We report two young patients with symptomatic sick sinus syndrome admitted for permanent pacemaker implantation (PPI). On evaluation with echocardiography, one of them was found to have persistent left superior vena cava and venography showed absent right superior vena cava also. He underwent PPI with leads inserted via left superior vena cava, coronary sinus, right atrium and right ventricle. The other patient was incidentally found to have interrupted inferior vena cava with azygos continuation while being planned for temporary pacemaker implantation. She underwent successful PPI. We would like to stress the importance of having a high suspicion for these systemic venous anomalies in patients presenting with sick sinus syndrome especially at young age. If we could diagnose preoperatively, we can avoid on table surprises.

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An alternative approach for endocardial pacemaker lead implantation in patient with persistent left superior vena cava

Cited by 5 publications

References 7 publications

Permanent Pacemaker Implantation in Patients With Isolated Persistent Left Superior Vena Cava From a Right-Sided Approach: Technical Considerations and Follow-Up Outcome

Permanent Pacemaker Implantation in Patients With Isolated Persistent Left Superior Vena Cava From a Right-Sided Approach: Technical Considerations and Follow-Up Outcome

A Case of Permanent Pacemaker Implantation From the Left Side in Persistent Left Superior Vena Cava – Technical Challenges in a Rare Presentation

Beware of venous anomalies in young patients with sick sinus syndrome: A report of two cases of sick sinus syndrome with systemic venous anomalies

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