Implantation of a Dual Chamber Pacemaker in a Patient with Persistent Left Superior Vena Cava

Abstract

A patient underwent dual chamber pacemaker implantation by puncture of the left subclavian vein. During the procedure we observed persistence of the left superior vena cava. A "J-shaped" atrial lead was used for ventricular pacing with excellent long-term results. This technique can be a valuable alternative when confronted with the problem of persistent left superior vena cava during pacemaker implantation.

Persistent left superior vena cava: Case reports and clinical implications

“…Permanent pacemaker leads for single chamber pacing were successfully advanced into the right ventricle through persistent LSVC as early as 1971 -1972 with good long-term results [16]. Technical advances have allowed successful positioning of right ventricular and right atrial leads for dual chamber pacing with excellent longterm pacing and sensing results [1,15]. The introduction of right ventricular lead may necessitate use of a pre-shaped stylet (pigtail, J-shaped, or L-shaped leads) or formation of a wide loop within the right atrium.…”

An alternative technique for implantation of a dual chamber pacemaker via a persistent left superior vena cava using a coronary sinus guiding catheter

“…Lead insertion is usually possible on the left side but can be complex, time consuming and involve prolonged radiation exposure [6][7][8]. When the right superior vena cava or innominate vein is also absent this presents an additional challenge.…”

A Novel Method of Placing Right Ventricular Leads in Patients With Persistent Left Superior Vena Cava Using a Conventional J Stylet

“…Approaches such as curving the stylet into a pigtail [22], using an L-shaped lead [14] or a wide loop have been described [23]. Dirix et al [24] used a pre-shaped J-lead, after manipulation in a posteroanterior plane, the tricuspid valve could easily be passed. However, the whole procedure was completed within 3 hours.…”