Left ventricular pacing in persistent left superior vena cava: a case series and potential application

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Persistent left superior vena cava (PLSVC) affects 0.3-2% of the population.
• Pacemaker implantation in PLSVC patients presents unique technical challenges.
• Traditional methods involve manipulating leads through the coronary sinus into the right ventricle.

Observation:

• This case series describes pacemaker implantation in three patients with PLSVC and bradycardia.
• Left ventricular (LV) epicardial veins were identified using contrast injection in the coronary sinus.
• Standard passive tined pacing leads were successfully guided into LV epicardial veins using hand-shaped stylets.

Findings:

• The novel approach required no specialized equipment.
• No procedural complications were observed.
• Chronic ventricular capture thresholds at 6 months were favorable (1.0 mV@ 0.4 ms).

Implications:

• Implanting standard leads into LV epicardial veins is a safe and effective alternative for PLSVC patients.
• This technique simplifies pacemaker implantation compared to traditional RV lead placement.
• Further clinical trials are warranted to confirm long-term efficacy and safety.