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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
PubMed

Insights

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.

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