Cardiac resynchronization therapy and transvenous lead extraction via an isolated subaortic left brachiocephalic vein

The subaortic left brachiocephalic vein is a rare and lesser-known systemic venous anomaly. The vein crosses the subaortic space and joins the lower part of the right brachiocephalic vein to form the superior vena cava. Cardiac or aortic arch anomalies are frequently observed in patients with subaortic left brachiocephalic veins, whereas the incidence of isolated subaortic left brachiocephalic vein was reported to be much lower. We present the case of a 74-year-old man with an isolated subaortic left brachiocephalic vein, who underwent cardiac resynchronization therapy with defibrillator (CRT-D) implantation. Subsequently, a transvenous lead extraction was performed 5 years after the implantation because a device infection was observed. These procedures were successful despite the aberrant course of the subaortic left brachiocephalic vein.To the best of our knowledge, this is the first report to demonstrate successful CRT-D implantation and transvenous lead extraction in a patient with a subaortic left brachiocephalic vein. This anomaly should be recognized before invasive transvenous procedures because the aberrant course of the left brachiocephalic vein may pose technical difficulties.

Left brachiocephalic vein aberrations detected during cardiac implantable electronic device (CIED) implantation or transvenous lead extraction have rarely been described. Such aberrations may result in procedural complexity. If a characteristic venogram of the subaortic left brachiocephalic vein is observed before CIED implantation or transvenous lead extraction, the anomaly should be considered and the procedures should be performed carefully.