An Innovation in Pacemaker Lead Implantation via Persistent Left Superior Vena Cava: The “3D Alpha Curve” Stylet

Abstract

Persistent left superior vena cava (PLSVC) draining into coronary sinus is typically detected incidentally during transcatheter interventions using left subclavian venous approach. In our experience, we have encountered this anomaly on a few occasions and in all these cases we successfully implanted leads in the right ventricle (RV) by shaping the stylet into a "U-shaped" or "pigtail-shaped" curve. Herein, we report a case of an adult male who underwent successful dual-chamber pacemaker implantation via PLSVC through left axillary venous approach. In this case, we were unable to deliver the lead into RV using aforementioned stylets. As an innovation, we used a "three-dimensional alpha curve"-shaped stylet that facilitated an easy entry of pacing lead into the RV.

Active fixation coronary sinus lead in a patient with persistence of left superior vena cava

“…The persistence of the left superior vena cava (LSVC) is the most common asymptomatic congenital alteration of the systemic thoracic venous return 1 . LSVC is often connected to the CS (92%), less to the left atrium (LA, 8%); drainage of venous blood from the upper left part of the body and from the left arm is guaranteed via the jugular vein, LSVC, and CS to the right atrium.…”

“…Persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the systemic venous return (an overall reported prevalence of up to 0.5% in the total population and up to 10%‐20% in patients with congenital heart defects), 1 and a device implantation can be challenging, especially in those involving cardiac resynchronization therapy and defibrillator (CRT‐D), as the coronary sinus in these patients is almost always very dilated, with small tributary branches; on this basis, it follows that it is very difficult to obtain an acceptable lead stability and thus to achieve optimal cardiac resynchronization. Even though similar cases are present in the literature, no standard implant technique has been identified for patients with this anomaly.…”

Right-Sided Permanent Pacemaker Implantation in Patients with Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava: 3-Case Series, Technique and Discussion

“…PLSVC may complicate cardiac device implantation, as transvenous lead placement is more challenging due to distorted anatomy. Most cases of devices implanted via a PLSVC published in the literature are leftsided implants, some employing special techniques [6][7][8][9]. The number of right-sided implants in patients with PLSVC and absence of RSVC is obviously lower and far fewer cases have been published, using a range of techniques [10][11][12].…”