Two Cases of Cardiac Implantable Electronic Device Placement via Persistent Left Superior Vena Cava

Abstract

Persistent left superior vena cava (PLSVC) is the most common variation of anomalous venous return to the heart and present in 0.1–0.5% of the general population. The left anterior cardinal veins typically obliterate during early cardiac development but failure of involution results in PLSVC. It is an asymptomatic congenital anomaly, usually discovered while performing interventions through the left subclavian vein or during cardiovascular imaging. PLSVC can be associated with cardiac arrhythmias and congenital heart disease. We present two cases of PLSVC: first, a 68-year-old male who presented with complete heart block, for which a temporary pacemaker was initially inserted followed by a permanent pacemaker; second, a 53-year-old female with a history of hypertension and ischemic cardiomyopathy with a left ventricular ejection fraction of 25%, and a survivor of sudden cardiac death, who underwent an implantable cardioverter-defibrillator (ICD) for secondary prevention. Both cases of PLSVC were detected incidentally during the transvenous approach to the heart. PLSVC was suspected by the unusually left medial position of the lead, while cineflouroscopy showed the venous trajectory toward the coronary sinus and drainage into the right atrium. It is technically difficult to cross the wire through the tricuspid valve when coming from the PLSVC and coronary sinus without making a loop in the right atrium, which is known as a wide loop technique. PLSVC is an uncommon anomalous anatomical variant and should be recognized appropriately by specialists who frequently carry out procedures through the left subclavian vein, such as implantation of permanent pacemaker, ICD and cardiac resynchronization therapy. It should also be recognized that wide loop formation of the right ventricular lead in the right atrium is helpful to cross the tricuspid valve and to affix the lead in the right ventricle.

A Novel Technique of Placing Desfibrillator Leads in Patients with Persistent Left Superior Vena Cava

“…The presence of PLSVC associated with the absence of RSVC is rare, and its appearance is related to the alterations in the development of the venous system of the fetus during pregnancy. 5) It is usually asymptomatic but may complicate the implantation of intracardiac devices. The main problem is the presence of an acute angle between the CS ostium and the TV, preventing adequate ori-entation of the lead toward the RV.…”

Persistent both superior vena cava (SVC) with subaortic membrane: A case report

“…When the coronary sinus receives a left superior vena cava or a hepatic vein, it is enlarged [4]. This venous anomaly is mostly asymptomatic and is encountered incidentally during cardiac device implantation, surgery or cardiovascular imaging [5].…”