Transvenous cardioverter-defibrillator placement via a persistent left superior vena cava

Persistent left superior vena cava (LSVC) is relatively uncommon. Due to its unanticipated location, large vessel injury is disproportionately common during transvenous intracardiac device implantation.

The purposes of this report are: (1) to remind surgeons/physicians of this (LSVC) anatomic abnormality and, (2) to reassure surgeons/physicians that successful dysarrhythmia rescue is feasible with intracardiac defibrillator devices despite the obligate atypical anatomic positioning of the defibrillator electrodes.

Catheter position in an LSVC appears fluoroscopically to traverse the left pleural space. The transvenous lead must negotiate a U-turn to enter the right ventricle.

Despite the unconventional configuration of the intracardiac electrodes necessitated by the anatomy of a persistent LSVC, successful defibrillation is possible.