Transvenous defibrillator implantation in a patient with persistent left superior vena cava

Abstract

Persistent left superior vena cava (LSVC) can be incidentally detected during pacemaker implantation through left pectoral side. There is technical difficulty of optimal site pacing and lead stability for right ventricle lead in such situation. We hereby report a case of successful single-chamber implantable cardioverter defibrillator (ICD) implantation in a 50 years-old male with LSVC. The practical issues related with right ventricle lead implantation and pacing/defibrillation parameters for ICD device are discussed.

Transfemoral snare–assisted placement of a left-sided defibrillator lead in the presence of a persistent left superior vena cava

“…There are several approaches that can be utilized for left-sided RV lead placement: 1) Implantation via the communicating vein, 5,6 that was absent in our case; 2) Use of J-tipped or manually shaped stylets with large curves, 3,9 however this technique can be particularly challenging with ICD leads compared to pacemaker leads and was unsuccessful in this particular case; and 3) Use of a coronary sinus delivery sheath, that can be used to direct leads towards the RV. 10,11 While CS delivery sheaths from most vendors can be used for pacemaker lead implantation, larger diameter sheaths for ICDs are not routinely available.…”

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

“…Given the acute angle at which the coronary sinus drains into the posterior part of RA, negotiating a lead into the RV through the anteriorly placed tricuspid orifice becomes technically demanding. Different authors have suggested using various hand‐shaped stylets, including “J‐shaped” atrial stylet, semicircular “U‐shaped” stylet, and “pigtail curve”‐shaped stylet to facilitate lead entry into the RV in such circumstances . A right ventricular septal stylet has also been used to deliver RV lead in a similar case reported by Feldman et al .…”

Complications of permanent cardiac pacing in patients with persistent left superior vena cava

“…Less experienced operators more often implant the system at the opposite chest side after following right-side venous angiography, if anatomical conditions make it possible. The difficulties during implantation and helpful specific instruments are often described in the literature [9][10][11][12]. Experienced operators select more favorable electrophysiological and hemodynamic solutions: epicardial left heart pacing/ /sensing and very exceptionally -defibrillation.…”