Utilizing preprocedural imaging and active fixation lead in cardiac resynchronization therapy device upgrade for persistent left superior vena cava

Chiang, Christopher; Chan, William K.; Yee, Raymond; Khan, Habib

doi:10.1016/j.hrcr.2021.11.003

Cited by 4 publications

(7 citation statements)

References 13 publications

(24 reference statements)

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“…In this case, satisfactory electrical results were achieved by means of QRS narrowing, but the authors provided no details regarding heart volume or ejection fraction. Another study reported achieving successful CRT criteria by using an active fixation CS lead in a patient with similar ejection fraction, although the study did not provide detailed volumetric echocardiographic details [ 18 ].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

The Challenges of Cardiac Resynchronization Therapy in Patients with Dilated Cardiomyopathy and Persistent Left Superior Vena Cava: A Case Report and Concise Literature Review

et al. 2023

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Heart failure with reduced ejection fraction (HFrEF) is a chronic and debilitating disease, which requires extensive diagnostic and treatment resources in order to achieve an acceptable quality of life for the patient. While optimal medical treatment remains at the core of the disease’s management, interventional cardiology also plays a very important role. However, in very rare situations, interventionists might find cases especially challenging due to the presence of venous anomalies, such as persistent left superior vena cava (PLSVC), anomalies that may go undiscovered during the patient’s lifetime until venous cannulation is necessary. While these types of malformations also pose challenges in regards to standard pacemaker implantation, cardiac resynchronization (CRT) devices pose several additional challenges due to the complexity of the device and the necessity of finding an optimal position for the coronary sinus (CS) lead. We present the case of a 55-year-old male patient with advanced heart failure due to dilated cardiomyopathy (DCM) and LBBB who was a candidate for CRT-D therapy, describing the investigations that led to the discovery of the PLSVC as well as the technique and results of the intervention, while comparing our case to similar cases found in recent literature.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

The Challenges of Cardiac Resynchronization Therapy in Patients with Dilated Cardiomyopathy and Persistent Left Superior Vena Cava: A Case Report and Concise Literature Review

et al. 2023

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“…However, patients with PLSVC and ARSVC have insufficient space to leave the LV lead because it does not pass through the right atrium. The active fixation lead can be fixed using side helix, decreasing the risk of LV lead dislodgement, even in patients with PLSVC and ARSVC 3–5 . In addition, the active fixation quadripolar lead can be fixed at any position of the CS branch and also has four electrodes, which increase the probability of LV lead placement in an easily accessible branch.…”

Section: Figurementioning

confidence: 99%

“…Because 90% of the PLSVC drains into the CS, the LV leads pass through in the following order: PLSVC, junction between PLSVC and CS, main body of the CS, and branch of the CS 1 . In a previous report, three‐dimensional CECT were used only to detect the CS branches 4 . However, the difficulty of the procedure is likely to depend more on the relationship between the junction site and the CS branches than on the number or location of the CS branches.…”

Section: Figurementioning

confidence: 99%

“…Several case reports of cardiac resynchronization therapy (CRT) device implantation through the PLSVC have been published, but left ventricular (LV) lead placement remains challenging in these patients. [2][3][4][5] Here, we report a successful cardiac synchronization therapy device upgrade using an active fixation quadripolar pacing lead in a patient with PLSVC and ARSVC.…”

mentioning

confidence: 99%

“…1 In a previous report, three-dimensional CECT were used only to detect the CS branches. 4 However, the difficulty of the procedure is likely to depend more on the relationship between the junction site and the CS branches than on the number or location of the CS branches.…”

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confidence: 99%

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Successful cardiac synchronization therapy device upgrade using an active fixation quadripolar pacing lead in a patients with persistent left superior vena cava and absent right superior vena cava

Nishiwaki

Shizuta

Tanaka

et al. 2023

Journal of Arrhythmia

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Challenges and pitfalls during CRT implantation in patients with persistent left superior vena cava

Akdis,

Vogler,

Sieren

et al. 2024

J Interv Card Electrophysiol

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Background Persistent left superior vena cava (PLSVC) is a rare venous anomaly, affecting 0.3–0.5% of the general population. Cardiac resynchronization therapy (CRT) implantation in patients with PLSVC is challenging due to a complex anatomy. Moreover, data on CRT implantation in this patient population is scarce. Our aim was to report a series of patients with PLSVC and CRT implantation focusing on challenges and pitfalls. Methods Electronic medical databases on patients with CRT implantation at the University Heart Centers in Zurich, Switzerland, and Lübeck, Germany, were screened for individuals with a PLSVC. Clinical and demographic characteristics as well as procedural data were reported in all patients. Results This study presents six cases with a median age of 66 years. CRT implantation was successful in five patients, leading to a reduced QRS duration and improved left ventricular ejection fraction. Atrial fibrillation, ischemic cardiomyopathy, valvular heart disease, and dilated cardiomyopathy were observed in this group as underlying conditions. Specialized tools, such as active fixation left ventricular leads, were utilized. One patient experienced major complications. Conclusions This case series shows that although challenging, conventional endovascular CRT implantation is feasible in PLSVC patients. Specialized tools for visualization and fixation may help. Our experiences highlight the importance of preprocedural evaluation of the anatomy and precise intervention planning. Graphical Abstract

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Utilizing preprocedural imaging and active fixation lead in cardiac resynchronization therapy device upgrade for persistent left superior vena cava

Cited by 4 publications

References 13 publications

The Challenges of Cardiac Resynchronization Therapy in Patients with Dilated Cardiomyopathy and Persistent Left Superior Vena Cava: A Case Report and Concise Literature Review

The Challenges of Cardiac Resynchronization Therapy in Patients with Dilated Cardiomyopathy and Persistent Left Superior Vena Cava: A Case Report and Concise Literature Review

Successful cardiac synchronization therapy device upgrade using an active fixation quadripolar pacing lead in a patients with persistent left superior vena cava and absent right superior vena cava

Challenges and pitfalls during CRT implantation in patients with persistent left superior vena cava

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