Trans-septal left ventricular endocardial pacing through a persistent left-sided superior vena cava

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Cardiac resynchronization therapy (CRT) improves outcomes in heart failure but requires complex lead placement.
• Coronary sinus (CS) lead implantation for CRT is not always feasible, particularly in complex congenital heart disease (CHD).
• Left ventricular (LV) endocardial lead placement presents a potential alternative pacing strategy.

Observation:

• A case of successful LV endocardial lead placement is presented in a patient with CHD and a persistent left-sided superior vena cava.
• The procedure utilized standard pacing equipment, indicating potential broad applicability.

Findings:

• Feasibility of LV endocardial pacing was demonstrated in a challenging CHD case.
• The procedure was technically successful and performed without immediate complications.
• Standard equipment was sufficient for successful endocardial LV lead implantation.

Implications:

• LV endocardial pacing may be a feasible and safe alternative CRT strategy in select CHD patients.
• This approach could expand CRT eligibility for patients with complex venous anatomy or prior failed CS lead placement.
• Further research is warranted to establish long-term outcomes and optimal patient selection for endocardial LV pacing in CHD.