Conduction system pacing in a patient with persistent left superior vena cava and absent right superior vena cava: a...

Physiologic pacing is increasingly used as an alternative when there is a failure in cardiac resynchronization therapy, with more challenging situations expected consequently.

An 83 year-old Caucasian man underwent attempted cardiac resynchronization therapy, but was found to have a persistent left superior vena cava and absence of a right superior vena cava. In addition, no suitable coronary sinus veins were found. Instead, conduction system pacing with a modified approach was used.

The presence of left superior vena cava is compatible with safe implantation of conduction system pacing, using conventional tools and with mild modification of typical technique.