Pacemaker Placement in Persistent Left Superior Vena Cava

Abstract

Persistent left superior vena cava (PLSVC) is a rare disorder which is asymptomatic and hence is usually discovered while performing interventions through the left subclavian vein. We present a case of a 78-year-old male who was undergoing elective placement of a permanent pacemaker for tachycardia – bradycardia syndrome with post-conversion pauses of up to nine seconds. After achieving access through the left subclavian vein the wire kept on going on the left side of the chest instead of crossing the midline to the right side. The wire was removed and contrast venography was done, PLSVC with dilated coronary sinus emptying into the right atrium was confirmed. There was some difficulty in passing the lead to the right ventricle even with the acute curve in the stylet. The sheath size was increased and a longer deflectable sheath was used and with the tip of the lead anteriorly the right ventricle was cannulated and the lead was affixed. There were good sensing and pacing parameters. Post procedure chest x-ray was done and the patient was discharged without any complications.

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

“…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.…”

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

“…Pacer lead insertion may be technically challenging due to misalignment of the CS ostium in relation to the tricuspid valve. Historically, operators have overcome these complications by formation of a pacer wire loop prior within the right atrium, utilizing CS guide catheters for directional support, or by insertion of a pacer lead into the CS branches [6][7][8].…”

Right-Sided Permanent Pacemaker Implantation in Patients with Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava: 3-Case Series, Technique and Discussion

“…PLSVC may complicate cardiac device implantation, as transvenous lead placement is more challenging due to distorted anatomy. Most cases of devices implanted via a PLSVC published in the literature are leftsided implants, some employing special techniques [6][7][8][9]. The number of right-sided implants in patients with PLSVC and absence of RSVC is obviously lower and far fewer cases have been published, using a range of techniques [10][11][12].…”