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A case of difficult temporary pacing

Goutam Datta1, Biswakesh Majumder, Avijit Bannerjee

  • 1Department of Cardiology, Institute of Post Graduate Medical Education and Research, West Bengal, Calcutta, India. goutamdattadn@yahoo.in

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|February 5, 2011
PubMed

Insights

A patient with complete heart block experienced syncope. A unique venous anomaly prevented standard pacing lead placement, requiring an alternative azygos vein approach for successful temporary cardiac pacing.

Area of Science:

  • Cardiology
  • Vascular Anatomy
  • Electrophysiology

Background:

  • Complete heart block can cause syncope, necessitating temporary cardiac pacing.
  • Standard transvenous lead placement relies on the inferior vena cava (IVC) connecting to the right atrium.

Observation:

  • A 55-year-old female presented with recurrent syncope due to complete heart block.
  • Attempted temporary pacing lead insertion via the IVC failed due to an anomalous venous connection.
  • A venogram revealed the IVC was not connected to the right atrium.

Findings:

  • An unusual venous anomaly was identified, presenting a challenge for cardiac pacing.
  • Successful temporary pacing lead placement was achieved by navigating the azygos vein and superior vena cava to the right atrium and ventricle.
  • The patient had no history of congenital heart disease or visceral heterotaxy, making the anomaly's origin unclear.

Implications:

  • This case highlights the importance of recognizing rare venous anomalies in cardiac procedures.
  • An alternative approach using the azygos vein is feasible for temporary cardiac pacing in complex venous anatomies.
  • Understanding such anomalies is crucial for successful interventional cardiology and electrophysiology procedures.

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