Research Information System
17th International Congress of Update in Cardiology and Cardiovascular Surgery. , İstanbul, Turkey, 5 - 07 November 2021, vol.9, no.1, pp.39-40, (Full Text)
Persistent left superior vena cava (LSVC) can be incidentally detected during pacemaker or ICD implantation through left pectoral side. We
hereby report a case of persistent LSVC, who had successful single chamber implantable cardioverter defibrillator (ICD) implantation with
dual coil active fixation lead.
Objective
The prevelance of persistant left superior vena cava syndrome in normal population is 0.3-0.5% and it is the most common venous return
anomaly of the heart. In the early periods of embryologic life, left anterior cardinal veins obliterate to form anatomical remnants. Failure of
this obliteration results in persistant left superior vena cava syndrome. Persistant left superior vena cava syndrome is mostly associated
with other congenital heart defects such as ASD, VSD, coarctation of the aorta and also seen with atrial fibrillation.
Usually asymptomatic, the syndrome ise mostly diagnosed during an invasive procedure through the left subclavian vein or by
cardiovascular imaging. In 2D echocardiography, the syndrome ise characterized by the dilatation of coronary sinus more than 1 cm. When
agitated saline is infused through the left antecubital vein the contrast is seen first in dilated coronary sinus, then in right atrium. Since the
lead is directed to the SVC or IVC in its natural course within the right atrium, it is technically challenging to direct the lead to the right
ventricle in patients with persistent left superior vena cava.
Method / Results: 67 year-old female patient who had a myocardial infarction 6 months ago presented with depressed left ventricle
ejection fraction of %20. An ICD was planned for primary prevention. An MRI was performed before the procedure with suspicion of an
intracardiac mass. She was then diagnosed with persistant left superior vena cava syndrome. Persistent left superior vena cava trace was
visualized by venography. No connection was seen between the left and right superior vena cavae. With the help of a U-angle stylet, the
lead was first passed through the the left superior vena cava and coronary sinus and then adcvanced from the right atrium to the right
ventricle. A wide loop was formed in the right atrium to direct the lead tip to the tricuspid valve. Active fixation was performed by placing
the lead to the apex of the right ventricle with a few maneuvers. Connection was established between the device (Medtronic D354VRG
Protecta XT VR (VVIR-D) and the lead, and the battery was implanted in the left pectoral region.During 6 months of follow-up he had a
ventricular tachycardia attack lasting long duration and terminated with electrical shock firing from the ICD.Therefore amiodarone was
started and metoprolol dosage was increased. Left ventricular assist device was implanted shortly before due to the deterioration of her
clinical status and heart failure symptoms .She is still alive and closely followed up by our clinic.
Conclusion
In our report, we demonstrated successful single-chamber dual-coil lead ICD implantation with a left subclavian approach in a case of
PLSVC.There is technical difficulty for finding of the optimal sensing and pacing site in such situation . Lead stability is another problem
because of the unusual cardiac anatomy. Therefore, active fixation right ventricular lead usage is regarded as mandatory.