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Right ventricular implantable cardioverter defibrillator lead implantation through a persistent left superior vena
1Department of Cardiac Surgery, Ludwig-Maximilians-University, Grosshadern Hospital, Munich, Germany.
Insights
A patient with drug-resistant ventricular tachycardia received an implantable cardioverter-defibrillator (ICD). The procedure was successful despite a rare anatomical variation, a persistent left superior vena cava (SVC).
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- A 60-year-old female patient presented with hypotensive ventricular tachycardia unresponsive to four antiarrhythmic medications.
- Preoperative imaging identified a persistent left superior vena cava (SVC) as the sole venous drainage from the upper body to the heart.
Observation:
- The patient required an implantable cardioverter-defibrillator (ICD) for refractory ventricular tachycardia.
- A persistent left SVC presented a unique anatomical challenge for device implantation.
Findings:
- A tripolar lead was successfully advanced through the persistent left SVC to the right ventricular apex under local anesthesia.
- An active can ICD device was implanted and demonstrated effective function.
Implications:
- This case highlights the successful implantation of an ICD in a patient with a persistent left SVC.
- It demonstrates that complex venous anomalies do not preclude effective ICD therapy for life-threatening arrhythmias.
- This approach may be applicable to other patients with similar anatomical variations requiring cardiac device implantation.
Abstract:
A 60-year-old woman required implantation of an ICD because of a hypotensive ventricular tachycardia refractory to four different antiarrhythmic drugs. Preoperative diagnostics revealed a persistent left SVC as the only major venous return from the upper part of the body to the heart. Under local anesthesia, a tripolar lead was advanced through the left SVC into the right ventricular apex. Following successful testing, an active can ICD device was implanted, which is functioning well during a follow-up period of 9 months.