Situs inversus totalis: A challenge for cardiac resynchronization therapy.

Area of Science:

• Cardiology and Medical Imaging
• Congenital Malformations
• Electrophysiology

Background:

• Situs inversus totalis (SIT) is a rare congenital condition affecting 1 in 10,000 live births, characterized by mirror-image transposition of visceral organs.
• Dextrocardia (DXC), often associated with SIT, involves the heart's displacement to the right thoracic cavity.
• Patients with SIT-DXC may present with complex cardiac conditions requiring advanced interventions.

Observation:

• A 60-year-old male patient with SIT-DXC, heart failure, extreme bradycardia, wide QRS complex, and left ventricular (LV) dysfunction was considered for CRT.
• The patient's mirror-image anatomy posed significant challenges for standard electrophysiological procedures.
• Tortuous coronary sinus (CS) branches complicated lead placement during the CRT implantation.

Findings:

• Successful cardiac resynchronization therapy (CRT) implantation was achieved despite the anatomical complexities of SIT-DXC.
• A subselection catheter was crucial for navigating the tortuous CS anatomy and achieving adequate lead implantation.
• The procedure demonstrated the feasibility of CRT in patients with complex congenital conditions.

Implications:

• This case highlights the need for tailored approaches and advanced techniques in managing heart failure patients with SIT-DXC.
• Successful CRT implantation in such complex anatomy can significantly improve patient outcomes and quality of life.
• Further research into specialized techniques for device implantation in rare congenital conditions is warranted.