Successful implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava

Persistent left superior vena cava is the most common thoracic venous abnormality which is usually asymptomatic, found incidentally during pacemaker implantation. The main problem is related to reaching the appropriate pacing site and ensuring stable lead placement.

We reported a successful implantation of a biventricular pacing and defibrillator device (CRT-D) via a persistent left superior vena cava in a 55-year-old man with dilated cardiomyopathy and severe heart failure. A persistent left superior vena cava was detected during CRT-D implantation. We managed to position electrodes in the right ventricular outflow tract, a posterior branch of the coronary sinus and in the right atrium.

Congenital anomalies of thoracic veins may complicate lead placement on the appropriate and stable position. The presented case demonstrates a successful biventricular pacing and defibrillator therapy device implantation in a patient with dilated cardiomyopathy and severe heart failure.