[Transvenous pacemaker implantation for sick sinus syndrome with mirror-image dextrocardia]

Area of Science:

• Cardiology
• Medical Imaging
• Congenital Heart Disease

Background:

• Sick sinus syndrome (SSS) is a common cause of cardiac arrhythmias.
• Dextrocardia, a rare congenital condition, involves the heart being on the right side of the chest.
• Anomalies of the systemic venous system frequently accompany dextrocardia.

Observation:

• A 45-year-old woman presented with dizziness and palpitations.
• Electrocardiogram revealed atrial fibrillation and a significant asystole.
• The patient had mirror-image dextrocardia with bilateral superior vena cava and absent inferior vena cava with azygos continuation.

Findings:

• A permanent endocardial bipolar demand pacemaker was successfully implanted.
• The implantation utilized the left superior vena cava due to the venous anomalies.
• Pre-procedural angiography is crucial for patients with dextrocardia and suspected venous anomalies.

Implications:

• This case underscores the critical need for pre-pacemaker implantation screening for venous anomalies in patients with dextrocardia.
• Understanding these complex anatomical variations is vital for safe and effective cardiac device implantation.
• Early identification of systemic venous anomalies can prevent procedural complications and optimize patient outcomes.