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His-bundle pacing in a patient with persistent left superior vena cava
Kheng-Siang Ng1, David Foo, Jimmy Lim
1The Heart Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. kheng_siang_ng@ttsh.com.sg
Pacing and Clinical Electrophysiology : PACE
|June 16, 2005
Summary
A persistent left superior vena cava allowed for successful dual-chamber pacemaker implantation. This anatomical variation facilitated optimal lead placement near the His bundle without specialized equipment.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Anatomical Variations
Background:
- Sick sinus syndrome necessitates pacemaker implantation for rhythm management.
- Dual-chamber pacemakers are standard for treating bradyarrhythmias.
- Persistent left superior vena cava (PLSVC) is a rare congenital anomaly.
Observation:
- A 53-year-old woman presented with sick sinus syndrome requiring a dual-chamber pacemaker.
- During implantation, a persistent left superior vena cava was identified.
- Active fixation leads were navigated through the PLSVC into the coronary sinus.
Findings:
- The right ventricular lead followed a natural course from the coronary sinus os.
- The lead tip was positioned close to the His bundle.
- No specialized guiding catheter was required for lead placement.
Implications:
- PLSVC can be an alternative venous access for cardiac device implantation.
- Understanding lead behavior in PLSVC can simplify procedures.
- This case highlights the potential for utilizing anatomical variations in electrophysiology.