Permanent right ventricular pacing through an anomalous left superior vena cava.

Abstract

Amikam, S., Lemer, J., and Riss, E. (1977). Thorax, 32,[777][778][779][780]. Permanent right ventricular pacing through an anomalous left superior vena cava. A persistent left superior vena cava can complicate the implantation of a transvenous pacemaker. In a patient who required a permanent pacemaker, this venous anomaly was discovered during the insertion of the electrode but it did not prevent long-term right ventricular pacing. This was achieved after the electrode had been manipulated through the coronary sinus and right atrium. A plan of management is proposed for dealing with this unexpected problem.The majority of permanent pacemakers implanted today are of the pervenous endocardial type. In most cases the endocardial electrode is introduced through the cephalic vein in the deltopectoral triangle. One of the problems that may be encountered when using the transvenous endocardial electrode is the presence of a persistent left superior vena cava, which drains directly into the coronary sinus. This problem usually occurs unexpectedly, and, from the few descriptions of the anomaly discovered during pacemaker implantation, it is evident that no definite method of management has been established to deal with such cases (Kukral, 1971;Rose et al., 1971;Garcia et al., 1972;Rubenfire et al., 1974).The purpose of this paper is to present an additional case of a persistent left superior vena cava (PLSVC) which was found during the introduction of a pervenous permanent endocardial electrode and to describe the manner in which we dealt with this problem. We also propose a plan of management to be applied when faced with PLSVC during the introduction of a transvenous electrode. Case reportA 61-year-old woman was diagnosed as suffering from sick-sinus syndrome five years before the present admission. She had episodes of rapid atrial fibrillation and supraventricular tachycardia which produced palpitation, chest pain, and dizziness.Apart from these episodes of tachydysrhythmia her heart rate was slow. In the few weeks before admission the frequency of the bouts of rapid atrial fibrillation increased and the attacks could be terminated only with the aid of anitidysrhythmic agents which produced persistent symptomatic sinus or nodal bradycardia. It was decided to treat the patient with a permanent endocardial pacemaker without the initial insertion of a temporary electrode.At operation a 58 cm length Medtronic bipolar electrode was introduced via the left cephalic vein into the left subclavian vein. Under fluoroscopic control it was found that the course taken by the electrode was through a persistent left superior vena cava draining into the coronary sinus.

Cardiac Resynchronization Therapy: Double Cannulation Approach to Coronary Venous Lead Placement via a Prominent Thebesian Valve

“…Variations in coronary venous anatomy which can inhibit coronary venous cannulation and lead placement are multiple and include coronary sinus unroofing, diverticulae, aneurysm, atresia, absence, anomalous vascular connections, and valves. 1,[9][10][11][12][13][14][15][16][17][18][19][20] In our case, the Thebesian valve was the obstacle to cannulation of the coronary sinus ostium from a superior approach via the left subclavian vein. The coronary sinus can be cannulated from a femoral approach.…”

Venoplasty of Innominate Bridge during Implantation of Single‐Chamber ICD in a Patient with a Persistent Left‐Sided Superior Vena Cava

“…1,2 Problems associated with the implantation of a right ventricular pacemaker or ICD lead through a LSVC have been previously reported. 3 Procedural options in this patient included closing the leftsided cephalic vein cutdown and proceeding with a right-sided cutdown and accessing the rightsided SVC via the right side. However, this option would have been time consuming and would have exposed the patient to the increased morbidity of a second incision.…”

Upper thoracic veins' patency in pacemaker implantation in behcet's disease: Diagnosis by echo-doppler and isotopic angiography

“…Patency of upper thoracic veins is a fundamental requirement of vascular access for patients in need of permanent endocardial pacing and/or automatic defibrillator. Insertion of a transvenous endocardial electrode is very difficult and even impossible in cases of venous thrombosis or congenital anomalies of the upper great veins, the most common of which is persistant left superior vena cava drainage to the coronary sinus [13]. As thrombosis of superficial and deep veins is a major feature of Behcet's disease, it presents an obstacle during implantation of permanent endocardial transvenous pacemaker and/or automatic defibrillator.…”