Implantation of a cardiac resynchronization therapy-defibrillator device in a patient with persistent left superior...

Area of Science:

• Cardiology
• Medical Devices
• Anatomy

Background:

• Persistent left superior vena cava (PLSVC) is a rare congenital anomaly.
• While often asymptomatic, PLSVC can present challenges during cardiovascular procedures.
• Cardiac device implantation, such as CRT-D, requires precise lead placement.

Observation:

• An 82-year-old male patient with heart failure (EF 20%) was diagnosed with PLSVC.
• The PLSVC drained into an enlarged right atrium via a dilated coronary sinus.
• This anatomical variation posed a potential obstacle for device lead insertion.

Findings:

• A novel approach was used to navigate the PLSVC.
• An active-fixation right ventricular lead was successfully advanced through the PLSVC to the apex.
• Atrial and coronary sinus leads were optimally positioned, enabling successful CRT-D implantation.

Implications:

• This case highlights a feasible technique for CRT-D implantation in patients with PLSVC.
• Successful implantation can improve outcomes for heart failure patients with complex anatomy.
• Awareness of PLSVC variations is crucial for interventional cardiologists.