Biventricular implantable cardiac defibrillator in dextrocardia with situs viscerum inversus

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Medical Imaging

Background:

• The case involves a patient with dextrocardia and situs viscerum inversus, presenting with a history of myocardial infarction, dilated cardiomyopathy, and severe left ventricular systolic dysfunction.
• The patient experienced recurrent heart failure episodes and ventricular tachyarrhythmias, with prior coronary artery bypass grafting for multivessel coronary artery disease.
• Further revascularization was precluded by coronary and graft anatomy evaluation, highlighting the need for alternative therapeutic strategies.

Observation:

• Electrocardiography revealed a left bundle branch block, indicating conduction system abnormalities.
• Echocardiography demonstrated significant interventricular mechanical dyssynchrony, a key factor in the patient's cardiac dysfunction.
• A comprehensive vascular and cardiac anatomy assessment was performed prior to intervention.

Findings:

• The patient underwent biventricular cardiac defibrillator implantation.
• The implantation was performed via a right-sided approach.
• Conventional fluoroscopic equipment was utilized for the procedure.

Implications:

• This case highlights the feasibility of biventricular cardiac defibrillator implantation in complex dextrocardia patients with situs inversus.
• Successful implantation offers a potential management strategy for refractory ventricular arrhythmias and heart failure in anatomically challenging scenarios.
• The use of conventional fluoroscopy underscores the adaptability of standard equipment in specialized cardiac interventions.