Pacemaker Implantation in Patient With Persistent Left Superior Vena Cava and Absent Right Superior Vena Cava

Abstract

Persistent left superior vena cava (LSVC) is an asymptomatic congenital heart disease. It is usually found incidentally on imaging, during central line placements or while undergoing electrophysiological procedures. We present a case of a 91-year-old female who initially presented with seizures and was diagnosed with tachy-brady syndrome. She was planned to undergo dual-chamber permanent pacemaker placement. However, during the procedure, she was incidentally found to have an LSVC without a right superior vena cava. Due to challenging anatomy, her pacemaker was changed to a single-chamber atrial lead pacemaker. This case highlights the clinical implications of this unusual structural anomaly, technical difficulties that arise alongside and solutions on how to overcome these issues in the context of pacemaker implantation.

Non-fluoroscopic Techniques for Catheter Ablation of Typical Atrioventricular Nodal Re-entry Tachycardia in a Pediatric Patient with Atypical Venous Anatomy

“… 6 , 7 In most cases, a persistent LSVC draining into the right atrium via the CS causes dilation of the CS ostium that can impact 3D EP mapping within a somewhat distorted triangle of Koch, 8 influence the optimal approach for implanting a transvenous pacemaker or defibrillator, or necessitate modified techniques in patients undergoing cardiac surgery. 9 …”

Vena cava izquierda persistente, inusual anatomía para la resincronización cardíaca: experiencia de implante y posterior cambio de generador

“…neral y de hasta el 10% de los pacientes con cardiopatía congénita. 6,7 Usualmente esta anomalía pasa desapercibida, diagnosticándose accidentalmente durante intervenciones como en nuestro caso de implante de TRC. En algunos casos su presencia se puede inferir ante la presencia de SC dilatado en el ecocardiograma transtorácico realizado antes de la implantación.…”

“…En los restantes casos, no existe comunicación entre ambas venas cavas, y por tanto el implante desde el lado izquierdo debe hacerse exclusivamente a través de la VCSIP. 4,7 Aunque la existencia de una VCSIP teóricamente facilita la canalización del SC debido a su dilatación (consecuencia del drenaje venoso que llega desde la VCSIP), también puede imposibilitar la venografía oclusiva, dificultar la cateterización selectiva de las venas debido a salidas anormales, angulaciones inusuales y por una mayor inestabilidad del apoyo de los catéteres. Además…”

Approaches for Successful Implantation of Cardiac Implantable Devices in Patients with Persistent Left Superior Vena Cava

“…As demonstrated in the first case, the RV lead has a large loop in the RA. Entry across the tricuspid valve can be facilitated by shaping the stylet into a cursive “L.” 5 If desired, the septal implantation of the RV lead can be achieved by a slight counterclockwise rotation of the stylet or by adding a secondary curve to the cursive “L” stylet.…”