Usefulness of a lead delivery system consisting of a fixed-shaped sheath and a lumenless bipolar lead in a patient with absent right and persistent left superior vena cava: A case report

Sasaki, Kenji; Tateishi, Sakura; Sawada, Chiharu

doi:10.1016/j.ipej.2018.08.003

Cited by 5 publications

(7 citation statements)

References 9 publications

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“…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 orientation of the lead towards the RV 7 . This is partially resolved by right venous access through the RSVC.…”

Section: Discussionmentioning

confidence: 99%

“…The most common technique consists of curving the stylets at different angles 8 . However, it is not always effective as it requires considerable operator experience and skill, in addition to the risk of RA perforation with electrode manipulation 7 . Subsequently, two alternative methods have been described, using a sheath for CS cannulation during cardiac resynchronization therapy 9 , or a Medtronic C315-S10 sheath frequently used for implantation of leads in the area of His or the left bundle branch area 7 , allowing both to orient and advance the electrodes towards the RV apex.…”

Section: Discussionmentioning

confidence: 99%

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A Novel Technique of Placing Right Ventricle Leads in Patients With Persistent Left Superior Vena Cava

García-Cano

Brouzet

Criado

et al. 2023

Preprint

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Background: Persistent left superior vena cava is the most common thoracic venous anomaly. It is usually asymptomatic, but it can make it difficult to implant intracardiac devices . Case presentation: We present a novel technique to facilitate right ventricular lead implantation in two patients with persistent left superior vena cava and the absence of the right superior vena cava. We used a fixed-curve Selectra 3D sheath (Biotronik), orienting the sheath towards the tricuspid valve by rotating it in a counter-clockwise direction. During follow-up, the electrodes remained stable. Discussion: Our technique was safe, simple and feasible for patients with this complex venous anatomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Novel Technique of Placing Right Ventricle Leads in Patients With Persistent Left Superior Vena Cava

García-Cano

Brouzet

Criado

et al. 2023

Preprint

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“…There are several approaches that can be utilized for left-sided RV lead placement: (1) implantation via the communicating vein, 5 , 6 which was absent in our case; (2) use of J-tipped or manually shaped stylets with large curves, 3 , 9 although 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 CS delivery sheath, which can be used to direct leads toward 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. Given the failure of traversing the tricuspid annulus despite trying manually shaped stylets, we resorted to a snare-assisted ICD lead implantation.…”

Section: Discussionmentioning

confidence: 99%

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

Ali

Mohammed

et al. 2021

HeartRhythm Case Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The results of a recently published study demonstrate the clinical safety of implanting the permanent transvenous pacemaker by using the active fixation right ventricle electrodes [ 20 ]. In a recently published case report, Sasaki et al describes the useful technique of implanting the ventricular electrode through a fixed sheath with which they cannulated the coronary sinus by using the left-side approach, which would have been difficult on the right-side because of the narrow angle between the right brachiocephalic system and the persistent left superior vena cava [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Permanent pacemaker implantation in a challenging anatomy: Persistent left superior vena cava

Bostan¹,

Astratinei²,

Tăbăcaru³

et al. 2020

Arch Clin Cases

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The persistence of the left superior vena cava is one of the most common abnormalities that could affect the thoracic venous return, despite its rare occurrence. It can usually be found as the only or in combination with other congenital cardiac abnormalities. Even though it is usually asymptomatic and it rarely has important consequences on the hemodynamics, it could sometimes represent a serious threat. In this regard, PLSVC often represents an incidental finding during an invasive procedure or imaging. We present an interesting case of a 66-year-old patient, with permanent atrial fibrillation and chronic kidney disease who presented to our clinic for a syncope due to complete atrioventricular block. The implant procedure was marked by the incidental intraprocedural finding of unusual venous anatomy. This anomaly included the absence of the superior vena cava, with the communication of the right brachiocephalic trunk and right subclavian vein with a persistent left superior vena cava which drainage directly into the coronary sinus. The right-side approach, as well as the limitation of using contrast-based venography, due to the kidney disease, made the procedure more difficult, but the final position of an active fixation ventricular lead was successfully achieved with optimal and stable pacing parameters through the formation of a particular curve of the lead stylet. Persistence of the left superior vena cava is a venous anomaly, which is frequently suspicioned at transthoracic echocardiography examination when the examiner found a dilated coronary sinus but diagnosed on the implant table of a cardiac device. These anomalies can pose problems and exponentially increase the procedural time even in experienced hands.

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Usefulness of a lead delivery system consisting of a fixed-shaped sheath and a lumenless bipolar lead in a patient with absent right and persistent left superior vena cava: A case report

Cited by 5 publications

References 9 publications

A Novel Technique of Placing Right Ventricle Leads in Patients With Persistent Left Superior Vena Cava

A Novel Technique of Placing Right Ventricle Leads in Patients With Persistent Left Superior Vena Cava

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

Permanent pacemaker implantation in a challenging anatomy: Persistent left superior vena cava

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