Transvenous dual-chamber pacemaker implantation in patients with persistent left superior vena cava

Abstract

Background Persistent left superior vena cava (PLSVC) is a rare congenital vascular anomaly. Permanent pacemaker implantation (PPI) in patients with PLSVC can be challenging because of the venous anomalies. We reported a case series of patients with PLSVC who underwent PPI with double active fixation leads. Methods From January 2012 to July 2016, 9 patients (three male and six females, mean age 68 ± 11 years) with PLSVC who received a dual-chamber pacemaker with double active fixation leads were enrolled retrospectively in this observational study. The indications for pacemaker implantation were symptomatic third-degree atrioventricular block in one and sick sinus syndrome in eight patients. Results PPI were implanted successfully in all 9 patients. Successful positioning of the ventricular leads at the right ventricular outflow tract (RVOT) septum with a “C” shaped stylet was achieved in 7 patients (77.8%). In the remaining two cases, the ventricular leads were placed in the right ventricular apex and the inferior free wall of the sub-tricuspid annulus. The atrial leads were placed at the lateral wall of the right atrium in all patients. Procedure time and fluoroscopy time were 85.3 ± 11.3 min and 4.5 ± 1.1 min respectively. During a mean follow-up of 4 years, no complications were observed and pacing parameters did not change significantly. Conclusion PPI through PLSVC may be technically feasible, safe, and effective. Double active fixation leads may be standard for patients with PLSVC and most of the ventricular leads could be placed at the RVOT septum.

Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava and Discrete Subaortic Stenosis Diagnosed in a Patient with Sick Sinus Syndrome: A Case Report and Brief Review of the Literature

“…In this case, the leads are advanced through the left SVC and the coronary sinus. Due to the acute angle between the ostium of the coronary sinus and the tricuspid valve, advancing the ventricular electrode through the tricuspid orifice is technically difficult and may be facilitated by forming a loop in the right atrium or by using a pre-shaped stylet [ 4 , 31 , 32 , 33 , 34 , 35 , 36 ]. Other pacing modalities such as leadless pacemaker or epicardial pacing systems might be an option whenever conventional therapy cannot be implemented [ 33 , 37 ].…”

Persistent Left Superior Vena Cava – Accidental Finding

“…The presence of PLSVC is important when the left subclavian vein is used for different catheterization procedures: Swan-Ganz catheterization, usage in renal dialysis (32), in oncological treatment (33) or in cardiac stimulator placement (34)(35)(36). In all of the abovementioned situations severe complications may occur: left subclavian vein thrombosis, cardiac arrhythmias, perforation of the coronary sinus, cardiac tamponade, cardiogenic shock or even death.…”

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

“…Several authors have proposed shaping the stylet manually in a U or J-shape, or looping the lead into the atrium, in order to pass through the tricuspid valve [ 4 , 8 ]. It is preferable to use active fixation leads in the case of selective site pacing, in order to avoid lead dislodgement [ 4 , 8 , 20 , 21 , 22 ]. Therefore, in our patient, we chose atrial and ventricular screw-in leads.…”