[Pacemaker lead implant via the persistent left superior vena cava]

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Anatomy

Background:

• Persistent left superior vena cava (PLSVC) is an uncommon congenital vascular anomaly affecting 0.5% of the population.
• It is typically asymptomatic and often discovered incidentally during procedures requiring central venous access, such as pacemaker implantation.
• PLSVC can present significant challenges for transvenous lead placement, particularly when using the left subclavian vein approach.

Observation:

• A case of a 26-year-old woman with Sick Sinus Syndrome where PLSVC was unexpectedly identified during pacemaker lead implantation.
• The anomalous venous structure was suspected due to the medial positioning of the lead, confirmed by venography showing drainage into the coronary sinus.
• Successful pacemaker implantation was achieved with the lead positioned in the right atrium.

Findings:

• PLSVC is a rare congenital abnormality that can be associated with cardiac rhythm disturbances.
• The anomaly can complicate the positioning of pacemaker and cardioverter-defibrillator leads, especially with left-sided approaches.
• Operators must be aware of PLSVC to navigate challenges in transvenous lead implantation.

Implications:

• Knowledge of PLSVC anatomy and potential complications is vital for interventional cardiologists and electrophysiologists.
• Alternative venous access or epicardial implantation may be necessary in cases of difficult coronary sinus cannulation.
• Understanding PLSVC is also relevant for other specialties utilizing transvenous catheters, including critical care and nephrology.