Cardiac Resynchronization Therapy Upgrade in a Patient with Dextrocardia and Situs Inversus Totalis, Facilitated by Coronary Sinus Cannulation with Electrophysiology Catheters from Both Femoral and Axillary Venous Approaches

Abstract

ABSTRACT. Cardiac resynchronization therapy in patients with

Situs inversus totalis: A challenge for cardiac resynchronization therapy

“…Moreover, the association with congenital heart block and acquired degeneration of the conduction system have been previously described. 2,3,5 Interestingly, in our case, the patient presented a conduction system disease that included symptomatic extreme bradycardia and intraventricular conduction delay along with severe LV dysfunction.…”

“…2 Indeed, less than 10% of individuals with SIT-DXC have associated congenital cardiac defects. 2 Anomalies of the venous vascular system (double, absent vena cava or persistent vena cava connected to the CS), single ventricle, double-outlet or double-inlet ventricles, and tricuspid atresia have been reported. 3,4 Therefore, SIT-DXC is usually associated with specific technical difficulties and there is not a standardized surgical approach due to the fact that every patient has an individual anatomy.…”

Usefulness of Decapolar catheter via femoral approach on CS cannulation during CRT device implantation

“…This case illustrated that the CS can be cannulated from a femoral approach with an EP catheter as a fluoroscopic landmark, if one anticipates difficult or abnormal anatomy for the CS cannulation from the subclavian approach. 13 …”

“…In case reported by Motallebi M in 2018, CRT upgrade was performed in a patient with dextrocardia and situs inversus totalis and was facilitated by CS cannulation with EP catheters from both femoral and axillary venous approaches. This case illustrated that the CS can be cannulated from a femoral approach with an EP catheter as a fluoroscopic landmark, if one anticipates difficult or abnormal anatomy for the CS cannulation from the subclavian approach 13 …”

“…This case illustrated that the CS can be cannulated from a femoral approach with an EP catheter as a fluoroscopic landmark, if one anticipates difficult or abnormal anatomy for the CS cannulation from the subclavian approach. 13 In case reported by Daniel Hofer and Alexander Breitenstein in 2020, dual approach from the subclavian vein using a snare through a sheath and from the femoral vein using a steerable EP catheter was performed. They presented an alternative approach as a bail-out strategy if all conventional options for CS cannulation have failed.…”