Cardiac implantable electronic devices in patients with persistent left superior vena cava—A single center experience

Abstract

Background: There are limited data on cardiac implantable electronic device implantation (CIED) in patients with persistent left superior vena cava (PLSVC).Objective: To describe the outcomes of implanting CIEDs with a focus on cardiac resynchronization therapy (CRT) in patients with PLSVC. Methods:We identified all patients with a PLSVC that underwent CIED implantation from December 2008 until February 2019 at our institution by querying the electronic medical record (n = 34). We then identified controls in a 3:1 fashion (n = 102) by matching on device type (CRT vs non-CRT). Procedure success, complications, fluoroscopy and procedural time were recorded. Outcomes were compared using a two-way analysis of variance test and conditional regression modeling for continuous and categorical variables, respectively.Results: A total of 34 patients with PLSVC underwent 38 procedures. Four patients underwent dual chamber system implantation followed by a subsequent upgrade to CRT. Thirteen patients underwent CRT implantation: one was implanted via the right subclavian while the rest were implanted via the PLSVC. Left ventricular (P = .06). Procedure and fluoroscopy times were significantly higher in the PLSVC as compared with the control group (97.7 vs 66.1 minute, P < .001 and 18.1 minute vs 8.7 minutes, P = .005, respectively).Conclusion: CIED implant in patients with PLSVC is feasible but technically more challenging and appears to be associated with higher risk of right ventricular lead dislodgment. K E Y W O R D S cardiac implantable electronic devices, ICD, left ventricular lead, pacemakers, persistent left superior vena cava † Bahjat Ghazzal and Dean Sabayon contributed equally to this study.This single center retrospective study demonstrates that although technically more difficult, implanting CIEDs through a persistent left SVC is feasible but seems to be associated with a higher risk of RV lead dislodgment. ORCID Soroosh Kianihttp://orcid.org/0000-0001-6389-0643Michael S. Lloyd http://orcid.org/0000-0002-0708-9330Mikhael F. El-Chami http://orcid.org/0000-0003-4978-7177 SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section.How to cite this article: Ghazzal B, Sabayon D, Kiani S, et al.Cardiac implantable electronic devices in patients with persistent left superior vena cava-A single center experience.

Conduction System Pacing in a Patient with Persistent Left Superior Vena Cava and Absent Right Superior Vena Cava.

“…In addition, due to the severe dilatation of the CS, balloon occlusion is unlikely to be properly performed, resulting in suboptimal angiography. Although, successful implantation of classic CRT system has been reported in some patients with persistent left SVC [6][7][8][9][10] . Bastian et al performed His pacing in a patient with persistent left SVC but from right venous access through a normal right SVC 11 .…”

A Double Rarity: Lost intravascular Catheter Guidewire in Persistent Left Superior Vena Cava and Coronary Sinus - A Case Report

“…Despite these risks, PLSVC does not hinder the successful implantation of a pacemaker, ICD, or CRT leads. 14 , 15 Moreover, there are numerous documented reports of successful and uneventful dialysis procedures, as well as numerous chemotherapy administration protocols using CVC inside PLSVC. 16 , 17 However, it is our perspective that if PLSVC has been previously diagnosed, it should only be considered as an alternative vascular access when other sites have failed.…”

Retrograde Snaring for Left Ventricular Lead Placement in the Presence of a Persistent Left Superior Vena Cava

“…3 Although asymptomatic, it can make LV lead implantation more challenging and can cause incorrect positioning, dislodgement, or failure. 4 Consequently, approaches to navigate narrow, tortuous, and complex anatomy have been described. [5][6][7][8] We describe a case in which retrograde snaring was employed to successfully deliver the LV lead through a PLSVC for CRT implantation.…”