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Left superior vena cava persistence in patients undergoing pacemaker or cardioverter-defibrillator implantation: a
M Biffi1, G Boriani, L Frabetti
1Institute of Cardiology, University of Bologna, Bologna, Italy.
Insights
The prevalence of persistent left superior vena cava (LSVC) in patients receiving pacemakers or cardioverter-defibrillators is similar to the general population. Left-sided implantation is feasible and safe, with reliable long-term device function.
Area of Science:
- Cardiovascular Medicine
- Anatomy
- Medical Device Technology
Background:
- A persistent left superior vena cava (LSVC) occurs in approximately 0.3% of the general population.
- LSVC is a significant anatomical consideration for left superior cardiac approaches, particularly during device implantation.
Purpose of the Study:
- To determine the prevalence of LSVC in patients undergoing pacemaker (PM) and cardioverter-defibrillator (CD) implantation.
- To evaluate the feasibility and outcomes of left-sided device implantation in patients with LSVC.
Main Methods:
- A 10-year retrospective study of patients undergoing PM or transvenous CD implantation using a left cephalic/left subclavian venous approach.
- Diagnosis of LSVC was made during lead placement, with specific attention to venous access and lead routing.
Main Results:
- LSVC was identified in 4 of 1,139 PM patients (0.34%) and 2 of 115 CD patients (1.7%).
- Overall prevalence of LSVC was 0.47% (6 of 1,254 patients).
- Left-sided PM/CD implantation was successful in most cases, with no lead dislodgement or device malfunction reported during follow-up (average 41 months).
Conclusions:
- The prevalence of LSVC in patients undergoing PM/CD implantation mirrors that of the general population.
- Left-sided implantation is achievable and yields reliable short-term and long-term outcomes.
- Pre-operative assessment of the right superior vena cava is recommended for planned right-sided implantations.
Objective:
The persistence of a left superior vena cava (LSVC) has been observed in 0.3% of the general population as established by autopsy. In the adult population, it is an important anatomic finding if a left superior approach to the heart is considered. The aim of the study was to evaluate the prevalence of a LSVC in patients undergoing pacemaker (PM) and cardioverter-defibrillator (CD) implantation.
Design:
We observed the prevalence of LSVC during a 10-year period; each patient undergoing PM or transvenous CD implantation received a left cephalic/left subclavian venous approach to the heart. With this technique, LSVC persistence is easily diagnosed during lead placement.
Results:
A total of 1,139 patients consecutively underwent PM implantation during 10 years: 4 patients had persistent LSCV (0.34%). Among 115 patients undergoing CD implantation, 2 patients with LSVC (1.7%) were observed. Overall LSVC persistence was found in 6 of 1,254 patients (0.47%). Two patients, one of whom had no right superior vena cava (RSVC), received a left-sided PM, whereas two other patients received right-sided devices. Both CD patients received a left-sided active-can device: the first patient with a right-sided lead tunneled to the left pectoral pocket, as a result of poor catheter handling through the LSVC and coronary sinus, and the second patient with a screw-in lead from LSVC. Long-term follow-up of these patients (average +/- SD, 41 +/- 26 months) revealed absence of lead dislodgment and appropriate device function regardless of lead implantation site.
Conclusions:
Persistence of LSVC in adults undergoing PM/CD implantation is similar to that of the general population (0.47% in our study). The left-sided implant can be achieved by stylet shaping and by use of active fixation leads in most patients, with a reliable outcome at short term in addition to appropriate device performance at follow-up. Assessment of the RSVC is advisable when planning a right-sided implantation, since a minority of patients lacks this vessel.