[Complex implantation of an automatic defibrillator-cardioverter through a left superior vena cava]

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• A 19-year-old female presented with a rare anatomical variation, a left superior vena cava, and a history of surgically corrected complete atrioventricular canal defect.
• Following an in-hospital sudden cardiac arrest, an automatic defibrillator-cardioverter was implanted via the left superior vena cava.

Observation:

• The patient experienced multiple inappropriate defibrillator discharges during the postoperative period.
• These events were attributed to myopotential oversensing, a known complication in patients with implanted cardiac devices.

Findings:

• Initial lead repositioning did not fully resolve the oversensing issue.
• A subsequent left submammarian thoracotomy allowed for the insertion of two epicardial leads, which ultimately provided an optimal result.

Implications:

• This case highlights the challenges in managing cardiac implantable electronic devices in patients with complex congenital heart anomalies.
• Successful management required a tailored approach involving lead revision and alternative lead placement strategies.
• Epicardial lead implantation can be an effective solution for device-related oversensing issues in select patient populations.