Active fixation of bipolar left ventricular lead through a persistent left superior vena cava

Area of Science:

• Cardiology
• Congenital Heart Disease
• Electrophysiology

Background:

• Persistent left superior vena cava (PLSVC) is a rare congenital anomaly of the thoracic venous system.
• Dilated and hypokinetic cardiomyopathy with severe left ventricular dysfunction presents significant challenges for cardiac device implantation.
• Valvular heart disease can further complicate cardiac management and device selection.

Purpose of the Study:

• To report a case of successful cardiac resynchronization therapy with a defibrillator (CRT-D) implantation in a patient with a persistent left superior vena cava.
• To highlight the management of a challenging congenital cardiac venous anomaly in the context of severe left ventricular dysfunction.

Main Methods:

• Diagnosis of persistent left superior vena cava via imaging (details not specified in abstract).
• Coronary angiography to rule out ischemic heart disease.
• Implantation of a biventricular defibrillator device (CRT-D).

Main Results:

• A 61-year-old patient with dilated cardiomyopathy, severe left ventricular dysfunction (LVEF 32%), and valvular disease was found to have a persistent left superior vena cava.
• Coronary angiography was negative for obstructive coronary artery disease.
• Successful implantation of a CRT-D device was achieved.

Conclusions:

• Cardiac resynchronization therapy with a defibrillator can be successfully implanted in patients with persistent left superior vena cava and severe left ventricular dysfunction.
• This case demonstrates the feasibility of managing complex congenital venous anomalies during cardiac device implantation.