Pacemaker implantation in a patient with isolated persistent left superior vena cava using a delivery catheter: a...

Persistent left superior vena cava (PLSVC) with absent right superior vena cava, also termed 'isolated PLSVC', is extremely rare. Permanent pacemaker implantation in patients with isolated PLSVC is often difficult by the usual subclavian approach due to the unique anatomy. With the advent of delivery catheters in recent years, implantation using the same system has been reported.

A 47-year-old woman with symptomatic sick sinus syndrome was admitted to our institution for permanent pacemaker implantation. Preprocedural cardiac multidetector computed tomography (MDCT) showed isolated PLSVC. We performed pacemaker implantation successfully via the left subclavian approach, using the C315 delivery catheter system. The leads were stable on chest radiography, and the sensing and capture thresholds were unchanged. After the procedure, we integrated the delivery catheter images with cardiac MDCT using Ziostation, and they were well matched with the fluoroscopic images. At the 1-month follow-up, the patient was free of heart failure symptoms and had decreased levels of N-terminal prohormone of brain natriuretic peptide.

The C315 delivery catheter system was considered an option for permanent pacemaker implantation in patients with isolated PLSVC. When performing permanent pacemaker implantation in patients with unusual venous anatomy, integrating the delivery catheter images with cardiac MDCT allows for appropriate preoperative catheter selection.