The combination of coronary sinus ostial atresia/abnormalities and a small persistent left superior vena cava—Opportunity for left ventricular lead implantation and unrecognized source of thromboembolic stroke

Zou, Fengwei; Worley, Seth J.; Steen, Torkel; McKillop, Matthew; Padala, Santosh K.; O’Donoghue, Susan; Candemir, Başar; Kanjwal, Khalil; Kaufman, Michael; Mouram, Sahar; Sellers, Matthew; Strouse, David; Thomaides, Athanasios; Nair, Devi G.; Hadadi, Cyrus A.; Kushnir, Alexander

doi:10.1016/j.hrthm.2021.05.004

Cited by 6 publications

(11 citation statements)

References 17 publications

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“…Levophase CS venography was utilized in most of the cases within this series. Through this method, the location of the CS ostium (therefore venous drainage), the existence of a connecting radical vein and the identity of a PLSVC can be confirmed 10,11 . This permits the planning of the procedure including direct contrast venography of the targeted veins to delineate the course of the vessels.…”

Section: Discussionmentioning

confidence: 91%

“…A PLSVC can occur with and without CSOA 10 . In the absence of CSOA, the pre‐dominant difficulty for lead implant arises from the acute angulations created by the left‐sided drainage 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Through this method, the location of the CS ostium (therefore venous drainage), the existence of a connecting radical vein and the identity of a PLSVC can be confirmed. 10,11 This permits the planning of the procedure including direct contrast venography of the targeted veins to delineate the course of the vessels. Often repeat procedures are required; the initial procedure commonly results in the identification of the abnormal anatomy and mapping of the vasculature whilst the second procedure results in implant following adequate planning.…”

Section: Discussionmentioning

confidence: 99%

“…A PLSVC can occur with and without CSOA. 10 In the absence of CSOA, the pre-dominant difficulty for lead implant arises from the acute angulations created by the left-sided drainage. 18 There are several corners to navigate: the subclavian-PLSVC junction (left-sided implants), the bend to access the RV, and in some cases, the tight angle to access the CS branches.…”

Section: Discussionmentioning

confidence: 99%

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Anatomical variations in coronary venous drainage: Challenges and solutions in delivering cardiac resynchronization therapy

Akhtar

Sohal

Kontogiannis

et al. 2022

Cardiovasc electrophysiol

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Aims To investigate the abnormalities of the coronary venous system in candidates for cardiac resynchronization therapy (CRT) and describe methods for circumventing the resulting difficulties. Methods From four implanting institutes, data of all CRT implants between October 2008 and October 2020 were screened for abnormal cardiac venous anatomy, defined as an anatomical variation not conforming to the accepted ‘normal’ anatomy. Patient demographics, procedural detail, and subsequent left ventricle (LV) lead pacing indices were collected. Results From a total of 3548 CRT implants, 15 (0.42%) patients (80% male) of 72.2 ± 10.6 years in age with an LV ejection fraction of 34 ± 10.3% were identified to have had an abnormal cardiac venous anatomy over the study period. There were 13 cases of persistent left side superior vena cava (pLSVC), five of which had coronary sinus ostium atresia (CSOA) including two with an “unroofed” coronary sinus (CS); one patient had a unique anomalous origin of the CS and one patient had an isolated CSOA. In total 14 patients (60% repeat attempt) had successful percutaneous implant under general anesthesia (46.7%) via the cephalic vein (59.1%), using the femoral approach (53.3%) for levophase venography and/or pull‐through, including one case of endocardial LV implant. Pacing follow‐up over 37.64 ± 37.6 months demonstrated LV lead threshold between 0.62 and 2.9 volts (pulsewidth 0.4–1.5 ms) in all cases; five patients died within 2.92 ± 1.6 years of a successful implant. Conclusion CRT devices can be implanted percutaneously even in the presence of substantial abnormalities of coronary venous anatomy. Alternative routes of venous access may be required.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anatomical variations in coronary venous drainage: Challenges and solutions in delivering cardiac resynchronization therapy

Akhtar

Sohal

Kontogiannis

et al. 2022

Cardiovasc electrophysiol

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“…A study by Zuo et al. [ 6 ] showed that CSOA with a small persistent LSVC (sPLSVC) facilitated LV lead placement into the desired CS branch in 20 patients and among those 40% of patients had one attempt of failed LV lead placement previously. They concluded that levophase CAG in LAO is the best projection to look for sPLSVC and its drainage into RA.…”

Section: Discussionmentioning

confidence: 99%

Marshall to the rescue in cardiac resynchronization therapy: Left ventricular lead placement in coronary sinus ostial atresia

Nath

Singh

Kuber

et al. 2022

Indian Pacing and Electrophysiology Journal

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This case highlights the importance of proper identification of congenital anomalies of the coronary sinus for the successful placement of left ventricular lead during cardiac resynchronization therapy device implantation. We discuss an alternate route for left ventricular lead placement via the vein of Marshall when the coronary sinus ostium in the right atrium was atretic and was facing difficulty initially in detecting the anomaly.

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Elucidating left atrial electrical potential with microelectrode catheter: A case of coronary sinus ostial atresia with small persistent left superior vena cava

Kimura,

Harita,

Haruna

2024

Pacing Clinical Electrophis

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A 51‐year‐old woman presented with recurring palpitations. Electrocardiography revealed narrow QRS tachycardia with short RP configuration. Computed tomography showed coronary sinus (CS) ostial atresia along with a small persistent left superior vena cava (PLSVC). Electrophysiological study identified the retrograde earliest atrial activation site (EAAS) at the CS ostium without decremental properties, and para‐Hisian pacing suggested retrograde atrioventricular nodal conduction. Using a 1.6‐Fr microelectrode catheter distally placed in the CS via the PLSVC, EAAS was confirmed within the left atrium, not the CS ostium. Transseptal approach revealed a left lateral accessory pathway, which was successfully eliminated.

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The combination of coronary sinus ostial atresia/abnormalities and a small persistent left superior vena cava—Opportunity for left ventricular lead implantation and unrecognized source of thromboembolic stroke

Cited by 6 publications

References 17 publications

Anatomical variations in coronary venous drainage: Challenges and solutions in delivering cardiac resynchronization therapy

Anatomical variations in coronary venous drainage: Challenges and solutions in delivering cardiac resynchronization therapy

Marshall to the rescue in cardiac resynchronization therapy: Left ventricular lead placement in coronary sinus ostial atresia

Elucidating left atrial electrical potential with microelectrode catheter: A case of coronary sinus ostial atresia with small persistent left superior vena cava

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