Pacemaker Implantation in a Patient with Isolated Persistent Left Superior Vena Cava Draining into the Left Atrium: A Case Report and Brief Literature Review

Abstract

Anomalies of the thoracic venous system are rare and usually discovered incidentally, but they become clinically relevant in the case of patients requiring cardiac device implantation. Persistent left superior vena cava is considered the most common venous drainage abnormality, with several anatomical variants that generate technical difficulties during pacemaker or defibrillator lead placement. We report a case of an isolated persistent left superior vena cava with abnormal drainage into the left atrium, associated with a hypoplastic right-sided superior vena cava, in a patient scheduled for permanent pacemaker implantation. Considering the patient’s anatomical characteristics, a transvenous approach proved unfeasible and the procedure was successfully accomplished via the surgical placement of a left ventricle epicardial lead. We aim to emphasize the clinical importance of such venous anomalies and to discuss the practical implications and challenges derived from these types of conditions, especially in the field of electrophysiology.

Isolated persistent left superior vena cava in adults: A case report and brief literature review

“…Therefore, the incidence of arrhythmia is high in PLSVC patients, including Wolf Parkinson White syndrome, pathological sinus syndrome, sinus bradycardia, and even sudden death [10,11] Usually, 80-90% of the persistent left superior vena cava passes through the coronary sinus or directly connects to the right atrium. Due to the lack of signi cant hemodynamic changes in anatomy, patients may have no obvious clinical symptoms or signs [12]. About 10% of isolated persistent left superior vena cava connected to the left atrium can cause venous blood to enter the left atrium and mix with oxygenated blood, resulting in functional changes.…”

Persistent Left Superior Vena Cava and Agitated Saline: A Strategically Thinking Sonographer’s Perspective

“…17 A case study by Totorean et al reports on an unknown PLSVC at the time of lead implantation, which deemed traditional transvenous implantation not feasible. 18 In addition to the implications on interventional procedures, PLSVCs predispose patients to clinical complications such as arrhythmias, embolism, decreased exercise tolerance, chest pain, and cyanosis. 19,20 Because these thoracic abnormalities are generally discovered incidentally and patients may be asymptomatic at the time of their intervention, 21 maintaining focus on all anatomy during TTE is paramount in a patient's care continuum.…”