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Technical considerations for CRT-D implantation in different varieties of persistent left superior vena cava

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Abstract

Purpose

The persistent left superior vena cava (PLSVC) is usually asymptomatic and creates a challenge when detected incidentally during cardiac resynchronization therapy defibrillator (CRT-D) implantation. The purpose of our cases is to show different anatomical variables of PLSVC and different strategies used for CRT-D implantation.

Methods

Four cases of PLSVC were presented. Pre-procedural bilateral venography was done to define anatomical variant of PLSVC. The side of approach and vein of approach were chosen according to the anatomical variant. Major challenges, electrical parameters, procedural times, long-term follow up, and complications were addressed.

Results

Two cases were de novo CRT-D implantation. One case was an extraction/re-implantation of the coil lead, and one case was an upgrading. In one case, CRT-D implantation was followed by AVN ablation. All cases had successful devices implantation. Two cases had isolated PLSVC: one of them had right approach and the other had left approach. One case had double SVC with no connecting brachiocephalic veins and underwent a left-sided approach. One case had double SVC with a small connecting brachiocephalic vein and had a left approach for implantation with using the small brachiocephalic vein for the RV lead. Electrical parameters were acceptable for all leads implanted. Long-term follow-up was done for 6 months to 5 years. One complication occurred (acute atrial lead dislodgement).

Conclusions

In our case series, the presence of PLSVC did not preclude successful placement of pacemaker/defibrillator leads using standard tools. Bilateral venography helped to decide the side and vein of lead insertion.

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References

  1. Zhong YL, Long X-M, Jiang L-Y, He B-F, Lin H, Luo P, et al. Surgical treatment of dextroversion, isolated persistent left superior vena cava draining into the left atrium. J Card Surg. 2015;30(10):767–70.

    Article  Google Scholar 

  2. Elison B, Evans D, Zanders T, Jeanmonod R. Persistent left superior vena cava draining into the pulmonary venous system discovered after central venous catheter placement. Am J Emerg Med. 2014;32(8):943.e1–3.

    Article  Google Scholar 

  3. Lai YC, Goh JC, Lim SH, Seah TG. Difficult pulmonary artery catheterization in a patient with persistent left superior vena cava. Anaesth Intensive Care. 1998;26(6):671–3.

    Article  CAS  Google Scholar 

  4. Tak T, Crouch E, Drake GB. Persistent left superior vena cava: incidence, significance and clinical correlates. Int J Cardiol. 2002;82(1):91–3. https://doi.org/10.1016/S0167-5273(01)00586-1.

    Article  PubMed  Google Scholar 

  5. Schummer W, Schummer C, Frober R. Persistent left superior vena cava and central venous catheter position: clinical impact illustrated by four cases. SurgRadiol Anat. 2003;25(3–4):315–21. https://doi.org/10.1007/s00276-003-0138-6.

    Article  CAS  Google Scholar 

  6. Golzio PG, Franco E, Chiribiri A. Atrio-ventricular synchronization by single VDD lead inserted through persistent left superior vena cava in patient with Turner's syndrome. Pacing ClinElectrophysiol. 2006;29(10):1181–2. https://doi.org/10.1111/j.1540-8159.2006.00513.x.

    Article  Google Scholar 

  7. Schummer W, Schummer C, Fröber R. Persistent left superior vena cava and central venous catheter position: clinical impact illustrated by four cases. SurgRadiol Anat. Jul-Aug 2003;25(3–4):315–21.

    CAS  Google Scholar 

  8. Sinha SK, Goel A, Razi M, et al. Permanent pacemaker implantation in patients with isolated persistent left superior vena cava from a right-sided approach: technical considerations and follow-up outcome. Cardiol Res. 2019;10(1):18–23. https://doi.org/10.14740/cr784.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Anselmino M, Marocco MC, Amellone C, Massa R. Hybrid right-left cardiac resynchronization therapy defibrillator implantation in persistent left superior vena cava. Europace. 2009;11(4):533–4. https://doi.org/10.1093/europace/eun371.

    Article  PubMed  Google Scholar 

  10. Zerbe F, Bornakowski J, Sarnowski W. Pacemaker electrode implantation in patients with left superior vena cava. Br Heart J. 1992;67:65–6.

    Article  CAS  Google Scholar 

  11. Gaba D, Kittusamy P, Ho RT, Pavri B, Greenspon AJ. Permanent pacing from a left ventricular vein in a patient with persistent left superior vena cava and absent right superior vena cava. J Intervent Card Electrophysiol. 2003;9:357–60.

    Article  Google Scholar 

  12. Daccarett M, Pai RK, Abedin M, Segerson NM, Hamdan MH. A novel technique for right ventricular lead placement in a patient with a persistent left superior vena cava. Europace. 2007;9:200–1.

    Article  Google Scholar 

  13. Williams TA Jr, Abe O, Mitre CA, Kassotis J. Low defibrillation threshold in a patient with a dual-coil defibrillator lead implanted through a persistent left superior vena cava. Pacing ClinElectrophysiol. 2012;35(9):e274–5. https://doi.org/10.1111/j.1540-8159.2012.03432.

    Article  Google Scholar 

  14. Beig JR, Dar MI, Tramboo NA, Hafeez I, Lone AA, Rather HA. An innovation in pacemaker lead implantation via persistent left superior vena cava: the "3D alpha curve" stylet. Pacing ClinElectrophysiol. 2017;40(9):1042–4. https://doi.org/10.1111/pace.13075.

    Article  Google Scholar 

  15. Mora G. A novel method of placing right ventricular leads in patients with persistent left superior vena cava using a conventional J stylet. Indian Pacing Electrophysiol J. 2014;14:65–74.

    Article  Google Scholar 

  16. Kumar S, Moorthy N, Kapoor A, Sinha N. A challenging dual chamber permanent pacemaker implantation in persistent left superior vena cava with absent right superior vena cava. J Cardiol Cases. 2012;5(2):e122–4. https://doi.org/10.1016/j.jccase.2011.12.003.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Roberts DH, Bellamy CM, Ramsdale DR. Implantation of a dual chamber pacemaker in a patient with persistent left superior vena cava. Int J Cardiol. 1992;36(2):242–3. https://doi.org/10.1016/0167-5273(92)90017-W.

    Article  CAS  PubMed  Google Scholar 

  18. Zardo F, Nicolosi GL, Burelli C, Zanuttini D. Dual-chamber transvenous pacemaker implantation via anomalous left superior vena cava. Am Heart J. 1986;112(3):621–2. https://doi.org/10.1016/0002-8703(86)90534-X.

    Article  CAS  PubMed  Google Scholar 

  19. Chen X, Yu Z, Bai J, Wang W, Qin S, Wang J, et al. Transvenous cardiac implantable electronic device implantation in patients with persistent left superior vena cava in a tertiary center. J Interv Card Electrophysiol. 2018;53(2):255–62. https://doi.org/10.1007/s10840-018-0377-4.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Spedali Civili Brescia, Brescia, Italy

    Luca Bontempi, Manuel Cerini, Francesca Salghetti, Davide Fabbricatore, Vincenzo Maiolo, Giulia Ghizzoni & Antonio Curnis

  2. Assiut University Heart Hospital, Assiut, Egypt

    Mohamed Aboelhassan

Authors
  1. Luca Bontempi
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  2. Mohamed Aboelhassan
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  3. Manuel Cerini
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  4. Francesca Salghetti
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  5. Davide Fabbricatore
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  6. Vincenzo Maiolo
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  7. Giulia Ghizzoni
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  8. Antonio Curnis
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Correspondence to Mohamed Aboelhassan.

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Bontempi, L., Aboelhassan, M., Cerini, M. et al. Technical considerations for CRT-D implantation in different varieties of persistent left superior vena cava. J Interv Card Electrophysiol 61, 517–524 (2021). https://doi.org/10.1007/s10840-020-00843-6

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  • DOI: https://doi.org/10.1007/s10840-020-00843-6

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