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Challenges and pitfalls during CRT implantation in patients with persistent left superior vena cava
Deniz Akdis1,2, Julia Vogler3, Malte-Maria Sieren4
1Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
Insights
Cardiac resynchronization therapy (CRT) implantation is feasible in patients with persistent left superior vena cava (PLSVC), despite anatomical challenges. Careful preprocedural evaluation and specialized tools can aid successful implantation.
Area of Science:
- Cardiology
- Medical Devices
- Anatomical Variations
Background:
- Persistent left superior vena cava (PLSVC) is a rare venous anomaly impacting 0.3-0.5% of the population.
- Cardiac resynchronization therapy (CRT) implantation presents unique challenges in patients with PLSVC due to complex anatomy.
- Limited data exists on CRT implantation outcomes in this specific patient group.
Purpose of the Study:
- To report a series of patients with PLSVC undergoing CRT implantation.
- To identify and discuss the challenges and potential pitfalls associated with CRT implantation in PLSVC patients.
Main Methods:
- Retrospective screening of electronic medical databases at University Heart Centers in Zurich and Lübeck.
- Inclusion of patients with both PLSVC and CRT implantation.
- Reporting of clinical, demographic, and procedural data.
Main Results:
- Six cases of CRT implantation in PLSVC patients were analyzed (median age 66 years).
- Successful CRT implantation was achieved in five patients, resulting in reduced QRS duration and improved left ventricular ejection fraction.
- Underlying conditions included atrial fibrillation, ischemic cardiomyopathy, valvular heart disease, and dilated cardiomyopathy. Specialized tools like active fixation left ventricular leads were used. One patient experienced major complications.
Conclusions:
- Conventional endovascular CRT implantation is feasible in PLSVC patients, though challenging.
- The use of specialized tools for visualization and fixation may improve procedural success.
- Thorough preprocedural anatomical evaluation and precise intervention planning are crucial for successful CRT implantation in PLSVC patients.
Background:
Persistent left superior vena cava (PLSVC) is a rare venous anomaly, affecting 0.3-0.5% of the general population. Cardiac resynchronization therapy (CRT) implantation in patients with PLSVC is challenging due to a complex anatomy. Moreover, data on CRT implantation in this patient population is scarce. Our aim was to report a series of patients with PLSVC and CRT implantation focusing on challenges and pitfalls.
Methods:
Electronic medical databases on patients with CRT implantation at the University Heart Centers in Zurich, Switzerland, and Lübeck, Germany, were screened for individuals with a PLSVC. Clinical and demographic characteristics as well as procedural data were reported in all patients.
Results:
This study presents six cases with a median age of 66 years. CRT implantation was successful in five patients, leading to a reduced QRS duration and improved left ventricular ejection fraction. Atrial fibrillation, ischemic cardiomyopathy, valvular heart disease, and dilated cardiomyopathy were observed in this group as underlying conditions. Specialized tools, such as active fixation left ventricular leads, were utilized. One patient experienced major complications.
Conclusions:
This case series shows that although challenging, conventional endovascular CRT implantation is feasible in PLSVC patients. Specialized tools for visualization and fixation may help. Our experiences highlight the importance of preprocedural evaluation of the anatomy and precise intervention planning.
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