An unusual ‘bow tie’ image in pacemaker implantation

Abstract

Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.

Left ventricular lead delivery system used to implant right ventricular lead via persistent left superior vena cava

“…Thus, it should be emphasized that the techniques for PM implantation through the PLSVC are quite rare. [3][4][5] In this case, we have elaborated on the successful and rapid implementation of PM implantation and right ventricular (RV) lead placement in tortuous persistent left superior vena cava via coronary sinus (CS) sheath technique.…”

“…[3][4][5] The abnormal anatomy of PLSVC may cause difficulties in lead fixation due to an angle between the orifice of the CS and the tricuspid valve. [3][4][5] According to this technique, it is easy to pass from PLSVC to RV via tricuspid valve with wire and deliver ventricular PM lead to RV CS sheath in tortuous and calcific vessel with or without PLSVC. In our case passing from tortuous PLSVC with CS sheath has been conducted safely and rapidly without any complications.…”

“…Thus, it should be emphasized that the techniques for PM implantation through the PLSVC are quite rare. 3 , 4 , 5 …”

“…Some other techniques were used for implantation of PM in different cases who had PLSVC like anchor balloon, C type stylet or catheter delivery system. 3 , 4 , 5 …”

“…Some other techniques were used for implantation of PM in different cases who had PLSVC like anchor balloon, C type stylet or catheter delivery system. [3][4][5] The abnormal anatomy of PLSVC may cause difficulties in lead fixation due to an angle between the orifice of the CS and the tricuspid valve. [3][4][5] According to this technique, it is easy to pass from PLSVC to RV via tricuspid valve with wire and deliver ventricular PM lead to RV CS sheath in tortuous and calcific vessel with or without PLSVC.…”