Title: Implantation of a single coil ICD via persistent left superior vena cava
Abstract: Persistent left superior vena cava (PLSVC) is a rare anatomic variation (0.07–0.13%) [ 1 Heye T. Wengenroth M. Schipp A. Johannes Dengler T. Grenacher L. Werner K.G. Persistent left superior vena cava with absent right superior vena cava: morphological CT features and clinical implications. Int. J. Cardiol. 2007; 116: e103-e105 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar , 2 Tak T. Crouch E. Drake G.B. Persistent left superior vena cava: incidence, significance and clinical correlates. Int. J. Cardiol. 2002; 82: 91-93 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar ] that is typically asymptomatic and discovered incidentally during device implantation [ 3 Fang C.C. Jao Y.T. Han S.C. Wang S.P. Persistent left superior vena cava: multi-slice CT images and report of a case. Int. J. Cardiol. 2007; 121: 112-114 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 4 Girerd N. Gressard A. Berthezene Y. Lantelme P. 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Cardiol. 2006; 111: 468-469 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 8 Korantzopoulos P. Kolios M. Nikas D. Goudevenos J.A. Implantable cardioverter defibrillator lead placement in the right ventricular outflow tract in a patient with Brugada syndrome and persistent left superior vena cava. Int. J. Cardiol. 2015; 181: 166-168 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 9 Roberts D.H. Bellamy C.M. Ramsdale D.R. Implantation of a dual chamber pacemaker in a patient with persistent left superior vena cava. Int. J. Cardiol. 1992; 36: 242-243 Abstract Full Text PDF PubMed Scopus (24) Google Scholar , 10 Cheng Z. Deng H. Cheng K. Chen T. Gao P. Fang Q. Implantation of a pacemaker in a patient with persistent left superior vena cava and absence of right superior vena cava. Int. J. Cardiol. 2013; 168: e53-e54 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar , 11 Dilaveris P. Sideris S. Toutouzas K. Gatzoulis K. 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Cardiol. 2015; 187: 235-236 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ] and is often achieved incidentally since hemodynamics in these patients can be normal and clinical symptoms are mostly absent [ 15 Guray Y. Yelgec N.S. Guray U. Yylmaz M.B. Boyaci A. Korkmaz S. Left-sided or transposed inferior vena cava ascending as hemiazygos vein and draining into the coronary sinus via persistent left superior vena cava: case report. Int. J. Cardiol. 2004; 93: 293-295 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 16 Yi Z. Sidhu J.S. Cheng J. A successful implantation of a dual-chambers cardioverter defibrillator for a patient with severe tortuous persistent left superior vena cava. Int. J. Cardiol. 2009; 133: e109-e110 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. The number of detected cases has increased with the increasing number of pacemaker implantation. The characteristic finding on two-dimensional transthoracic echocardiography was a dilated coronary sinus (CS) with the diameter over 1 cm. The venous angiography was the gold standard for the diagnosis of PLSVC [ [10] Cheng Z. Deng H. Cheng K. Chen T. Gao P. Fang Q. Implantation of a pacemaker in a patient with persistent left superior vena cava and absence of right superior vena cava. Int. J. Cardiol. 2013; 168: e53-e54 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar ]. Important clinical implications include difficulties in central venous access or cardiac pacemaker placement as well as management consequences in cardiothoracic surgery [ [1] Heye T. Wengenroth M. Schipp A. Johannes Dengler T. Grenacher L. Werner K.G. Persistent left superior vena cava with absent right superior vena cava: morphological CT features and clinical implications. Int. J. Cardiol. 2007; 116: e103-e105 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar ] or cardiac ablation procedures [ 9 Roberts D.H. Bellamy C.M. Ramsdale D.R. Implantation of a dual chamber pacemaker in a patient with persistent left superior vena cava. Int. J. Cardiol. 1992; 36: 242-243 Abstract Full Text PDF PubMed Scopus (24) Google Scholar , 17 Sakabe K. Fukuda N. Wakayama K. Nada T. Shinohara H. Tamura Y. Radiofrequency catheter ablation for atrioventricular nodal reentrant tachycardia in a patient with persistent left superior vena cava. Int. J. Cardiol. 2004; 95: 355-357 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 18 Hirai Y. Chou C.C. Wen M.S. Catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with complete situs inversus, atrial septal defect and "inverse" persistent left superior vena cava. Int. J. Cardiol. 2007; 115: e12-e14 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ]. A 65-year-old male patient with ischemic cardiomyopathy was referred to our clinic for primary prevention implantable cardiac defibrillator (ICD) implantation. The presence of a PLSVC leading to a dilated CS was incidentally found during advancement of the guide wire from the left subclavian vein to the superior vena cava (SVC) and was subsequently verified on venography (Video 1). The guidewire did not advance to the right SVC after routine puncture of the left axillary vein. Instead, an acute downward angulation was performed on the left side, parallel to the right-sided vena cava. A venogram was performed, and the diagnosis of PLSVC that descended into the coronary sinus (CS) was confirmed (Video 2). In first attempt, the ICD lead retrogradly was placed within CS (Video 3); therefore pacing showed atrial premature stimulation. Therefore, traversing the tricuspid valve and obtaining a stable position in the right ventricle required prolonged manipulation. Finally, it could be implanted with retrograde loop by hand-shaped stylet (Video 4, Video 5). The appropriate sensing and pacing threshold confirmed that the ideal site via the single coil active lead had been reached, and the ICD was connected. (See Fig. 1.)
Publication Year: 2016
Publication Date: 2016-01-18
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 2
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