Implantation of a Dual-Chamber Automatic Cardioverter Defibrillator in a Patient with Persistent Left Superior Vena Cava: Case Report and Brief Literature Review

Abstract

Persistence of the left superior vena cava (PLSVC) is a congenital anomaly reported in 0.3–0.5% of patients. Due to the multiple and complex anatomical variations, transvenous lead placement can become challenging. We report the case of a 47-year-old patient diagnosed with non-ischemic dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF—27%), who was referred to our clinic for implantation of a dual-chamber cardioverter defibrillator for primary prevention of sudden cardiac death. During the procedure we encountered an abnormal guidewire trajectory and after venographic examination we established the diagnosis of persistent left superior vena cava. After difficult implantation of a 7F defibrillation lead through the coronary sinus, we managed to place the atrial lead through a narrow brachiocephalic vein into the right atrial appendage. In this paper, we aim to illustrate the medical and technical implications of implanting a cardioverter defibrillator in patients with PLSVC, highlighting the benefit of identifying and utilizing both the innominate vein, and the left superior vena cava and coronary sinus for placement of multiple leads, which would otherwise have been impossible.

Utilizing preprocedural imaging and active fixation lead in cardiac resynchronization therapy device upgrade for persistent left superior vena cava

“…However, one of the main challenges that still remains in patients with PLSVC is proper lead placement, lead stability, and preventing lead dislodgement. 12 During left-sided placement, it can be technically challenging to advance and correctly position the defibrillator lead in the right ventricle due to the sharp takeoff between the CS opening into the right atrium and the tricuspid valve. The number of turns that the lead must make to reach this destination increases the risk for dislodgement.…”

Cardiac Implantable Electronic Devices in Different Anatomical Types of Persistent Left Superior Vena Cava: Case Series and Brief Review of the Literature

“…Among these cases, we identified six patients who had PLSVC, which leads to an incidence of at least 0.15% of this anomaly in the group of patients who required implantable devices in our clinic. It should be mentioned that, in these cases, we met several types of this congenital anomaly (two cases of type II, two cases of type III A, and two cases of type III B according to Schummer’s classification); however, in this article, we will present only four cases, since two of them have already been published [ 5 , 6 ]. None of these patients met the criteria for cardiac resynchronization therapy.…”