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Plášek J, Vrtal J, Šipula D, Grézl T, Václavík J. Slittable sheath supported right ventricular pacing lead implantation in persistent left superior vena cava with absent right superior vena cava: a case report. J Med Case Rep 2023; 17:346. [PMID: 37574534 PMCID: PMC10424350 DOI: 10.1186/s13256-023-04073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Persistent left superior vena cava (PLSVC) is the most common variant of systemic venous drainage. In the absence of the right superior vena cava (RSVC), implantation of a right ventricular pacing lead may be challenging. Therefore specific implantation techniques and experiences in PLSVC are worth reporting. CASE PRESENTATION We present a case report of a 90-year-old Caucasian female patient with PLSVC during single chamber pacemaker implantation due to the third-degree atrioventricular block. With common implantation techniques, we did not even reach the right ventricle. Therefore slittable CPS Direct ™ Universal sheath was employed to overcome the acute angle from PLSVC to tricuspid valve and ensure more fixation stability for longer 100-cm right ventricular lead placement. CONCLUSION This case demonstrates safe implantation of 100-cm long right ventricular bipolar active fixation pacing lead using common slittable CPS Direct ™ Universal sheath after failed attempts with "C" and "J" stylet shaped electrode. This sheath provides different angle towards tricuspid valve and more fixation stability in patient with PLSVC and absent connection to right atrium.
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Affiliation(s)
- Jiří Plášek
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic.
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21, Prague, Czech Republic.
- Centre for Research on Internal Medicine and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic.
| | - Jiří Vrtal
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
| | - David Šipula
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
| | - Tomáš Grézl
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
| | - Jan Václavík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
- Centre for Research on Internal Medicine and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
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Borges S, Moreira JI. The lead leads the way. Neth Heart J 2021; 30:445-446. [PMID: 34449044 PMCID: PMC9402879 DOI: 10.1007/s12471-021-01625-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- S Borges
- Cardiology Department, Centro Hospitalar de Trás os Montes e Alto Douro, Vila Real, Portugal.
| | - J I Moreira
- Cardiology Department, Centro Hospitalar de Trás os Montes e Alto Douro, Vila Real, Portugal
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Demșa I, Crișu D, Haba CMȘ, Ursaru AM, Afrăsânie VA, Costache II, Petriș AO, Tesloianu DN. Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava and Discrete Subaortic Stenosis Diagnosed in a Patient with Sick Sinus Syndrome: A Case Report and Brief Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10100847. [PMID: 33086768 PMCID: PMC7589949 DOI: 10.3390/diagnostics10100847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/17/2020] [Accepted: 10/18/2020] [Indexed: 01/20/2023] Open
Abstract
A persistent left superior vena cava (PLSVC) is the most frequent anomaly of the venous drainage system. While both a right and left superior vena cava (SVC) are usually present, a unique, left-sided SVC, also known as an isolated PLSVC, accounts for only 10–20% of cases. It is frequently associated with arrhythmias and other congenital cardiac anomalies. Though it is usually an asymptomatic condition, it may pose significant problems whenever central venous access is needed. We report a case of an isolated PLSVC that was diagnosed incidentally during pacemaker implantation for sinus node dysfunction. The venous anomaly was associated with subvalvular aortic stenosis determined by a subaortic membrane; this particular association of congenital cardiovascular anomalies is a rare finding, with only a few cases reported in the literature. We aim to highlight the clinical and practical implications of this condition, as well as to discuss the embryonic development and diagnostic methods of this congenital defect.
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Affiliation(s)
- Irina Demșa
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
| | - Daniela Crișu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
- Correspondence: ; Tel.: +40-745-264-550
| | - Cristian Mihai Ștefan Haba
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
- Department of Internal Medicine, “Grigore.T. Popa” University of Medicine and Pharmacy, str. Universitatii nr. 16, 700083 Iași, Romania
| | - Andreea Maria Ursaru
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
| | - Vlad-Adrian Afrăsânie
- Department of Medical Oncology, “Grigore.T. Popa” University of Medicine and Pharmacy, str. Universitatii nr. 16, 700083 Iași, Romania;
| | - Irina Iuliana Costache
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
- Department of Internal Medicine, “Grigore.T. Popa” University of Medicine and Pharmacy, str. Universitatii nr. 16, 700083 Iași, Romania
| | - Antoniu Octavian Petriș
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
- Department of Internal Medicine, “Grigore.T. Popa” University of Medicine and Pharmacy, str. Universitatii nr. 16, 700083 Iași, Romania
| | - Dan Nicolae Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
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Technical considerations for CRT-D implantation in different varieties of persistent left superior vena cava. J Interv Card Electrophysiol 2020; 61:517-524. [DOI: 10.1007/s10840-020-00843-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
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Ghazzal B, Sabayon D, Kiani S, Leon AR, Delurgio D, Patel AM, Lloyd MS, Westerman S, Shah A, Merchant FM, El-Chami MF. Cardiac implantable electronic devices in patients with persistent left superior vena cava-A single center experience. J Cardiovasc Electrophysiol 2020; 31:1175-1181. [PMID: 32237003 DOI: 10.1111/jce.14460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are limited data on cardiac implantable electronic device implantation (CIED) in patients with persistent left superior vena cava (PLSVC). OBJECTIVE To describe the outcomes of implanting CIEDs with a focus on cardiac resynchronization therapy (CRT) in patients with PLSVC. METHODS We identified all patients with a PLSVC that underwent CIED implantation from December 2008 until February 2019 at our institution by querying the electronic medical record (n = 34). We then identified controls in a 3:1 fashion (n = 102) by matching on device type (CRT vs non-CRT). Procedure success, complications, fluoroscopy and procedural time were recorded. Outcomes were compared using a two-way analysis of variance test and conditional regression modeling for continuous and categorical variables, respectively. RESULTS A total of 34 patients with PLSVC underwent 38 procedures. Four patients underwent dual chamber system implantation followed by a subsequent upgrade to CRT. Thirteen patients underwent CRT implantation: one was implanted via the right subclavian while the rest were implanted via the PLSVC. Left ventricular (P = .06). Procedure and fluoroscopy times were significantly higher in the PLSVC as compared with the control group (97.7 vs 66.1 minute, P < .001 and 18.1 minute vs 8.7 minutes, P = .005, respectively). CONCLUSION CIED implant in patients with PLSVC is feasible but technically more challenging and appears to be associated with higher risk of right ventricular lead dislodgment.
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Affiliation(s)
- Bahjat Ghazzal
- Department of Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Dean Sabayon
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Soroosh Kiani
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Angel R Leon
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - David Delurgio
- Division of Cardiac Electrophysiology, Emory University, Atlanta, Georgia
| | - Anshul M Patel
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael S Lloyd
- Division of Cardiovascular Electrophysiology, Emory University, Atlanta, Georgia
| | - Stacy Westerman
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anand Shah
- Division of Cardiovascular Electrophysiology, Emory University, Atlanta, Georgia
| | - Faisal M Merchant
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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van den Broek LM, Westra SW, Evertz R, Boulaksil M. Lead detour. Neth Heart J 2019; 28:56. [PMID: 31407147 PMCID: PMC6940402 DOI: 10.1007/s12471-019-01321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- L M van den Broek
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S W Westra
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Evertz
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Boulaksil
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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