Heart block in dextrocardia and situs inversus: a case report

Implantation of a completely right sided subcutaneous cardioverter-defibrillator in a patient with situs inversus dextrocardia

Dextrocardia is a congenital anomaly where the heart is abnormally located in the right hemithorax. In these patients, the implementation of transvenous implantable cardioverter-defibrillator (TV-ICD) can be technically challenging and pose a higher risk of complications than the general population. We present the case of a male patient that was successfully submitted to right-sided implantation of subcutaneous ICD (S-ICD) as an alternative to transvenous ICD (TV-ICD) for primary prevention of sudden cardiac death. This option is not only feasible but may potentially be ideal for these patients, as it circumvents challenges and potential complications of TV-ICD insertion.

Cardiac Resynchronization Therapy Upgrade in a Patient with Dextrocardia and Situs Inversus Totalis, Facilitated by Coronary Sinus Cannulation with Electrophysiology Catheters from Both Femoral and Axillary Venous Approaches

Cardiac resynchronization therapy in patients with dextrocardia with situs inversus totalis can be technically challenging. There are few case reports of cardiac resynchronization therapy implantation in these individuals. Here, we describe a procedure of cardiac resynchronization therapy upgrade in a patient with dextrocardia and situs inversus totalis facilitated by coronary sinus cannulation from both the femoral and axillary venous approaches.

Implantable cardioverter-defibrillator in a patient with dextrocardia situs inversus

BACKGROUND

Dextrocardia is a congenital anomaly, which may have coexistent coronary artery disease (CAD), arrhythmias and conventional indications for device therapy. However, the implantation of transvenous leads can be technically challenging and the approach needs to be tailored to the patient's individual anatomy.

CASE PRESENTATION

A 54-year-old male with dextrocardia situs inversus and ischemic left ventricular dysfunction developed ventricular tachycardia and fibrillation. Therefore, left- sided approach, dual chamber implantable cardioverter-defibrillator (ICD) was applied using a conventional method and standard equipment after complete evaluation of cardiac anatomy and vascular assessment.

CONCLUSION

Electrical device implantation in patients with dextrocardia is possible after obtaining complete information about anatomy and/or coexisting congenital abnormalities, which helps in obtaining appropriate implantation approach.

Transvenous permanent pacemaker implantation in dextrocardia: technique, challenges, outcome, and a brief review of literature

AIMS

Dextrocardia is a rare congenital anomaly. Pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy and associated anomalies. The literature regarding implantation of pacemaker in dextrocardia is scarce.

METHODS AND RESULTS

The study involved retrospective analysis of records of patients with dextrocardia who had undergone pacemaker implantation between January 2006 and July 2013 from a single centre. Six patients with dextrocardia (five males and one female) underwent permanent pacemaker implantation (PPI) between January 2006 and July 2013. Of them, three had situs solitus dextrocardia and three situs inversus dextrocardia. All three patients with situs solitus dextrocardia had associated corrected transposition of great arteries. The indication for pacemaker implantation was symptomatic complete atrioventricular (AV) block in four, high-grade AV block in one, and sinus node dysfunction in one patient. A favourable outcome was noted during a mean follow-up of 3.9 years (4 months to 7 years) with one patient needing a pulse generator replacement.

CONCLUSION

Permanent pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy. Use of a technique employing angiography to delineate chamber anatomy and relationship can assist the operator during such difficult PPIs. The medium- and long-term survival after a successful pacemaker implantation in dextrocardia is favourable.