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Brouzet TA, García-Cano L, Ibáñez-Criado JL, García-Fernández A, Monteagudo-Viana M, Martínez-Martínez JG, Ibáñez-Criado A. A Novel Technique of Placing Desfibrillator Leads in Patients with Persistent Left Superior Vena Cava. Int Heart J 2023; 64:1162-1165. [PMID: 37967980 DOI: 10.1536/ihj.23-315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Persistent left superior vena cava is the most common thoracic venous anomaly. It is usually asymptomatic, but it can make implanting intracardiac devices difficult.We present a novel technique to facilitate desfibrillator lead implantation in patients with persistent left superior vena cava and the absence of the right superior vena cava. We used a fixed-curve Selectra 3D 65-42 cm sheath (Biotronik), orienting it toward the tricuspid valve (TV) by rotating it counter-clockwise. During follow-up, the electrodes remained stable.Our technique was safe, simple, and feasible for patients with this complex venous anatomy.
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Affiliation(s)
- Thomas André Brouzet
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | - Laura García-Cano
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | - José Luis Ibáñez-Criado
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | - Amaya García-Fernández
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | | | - Juan Gabriel Martínez-Martínez
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | - Alicia Ibáñez-Criado
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
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Wang X, Yang Y, Dong J, Wang X, Zheng Y, Chen J, Shen Y, Wang H. Analysis of six cancer patients with persistent left superior vena cava identified during central venous access device placement via an intracavitary electrocardiogram. J Vasc Access 2023; 24:802-808. [PMID: 34585623 DOI: 10.1177/11297298211045576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.
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Affiliation(s)
- Xinpeng Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yong Yang
- Department of Critical Care Medicine (ICU), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jing Dong
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Xiaozheng Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yuanyuan Zheng
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jie Chen
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yanfen Shen
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Hongzhi Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
- Department of Critical Care Medicine (ICU), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
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Electroanatomic mapping in atrioventricular junction ablation and pacemaker implantation for permanent atrial fibrillation associated with persistent left superior vena cava. HeartRhythm Case Rep 2022; 8:93-98. [PMID: 35242546 PMCID: PMC8858739 DOI: 10.1016/j.hrcr.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Narikawa M, Kiyokuni M, Taguchi Y, Hosoda J, Ishigami T, Ishikawa T, Tamura K, Kimura K. Successful implantation of left ventricular lead for a cardiac resynchronization therapy defibrillator through a persistent left superior vena cava using the anchor balloon technique. J Cardiol Cases 2021; 25:308-311. [DOI: 10.1016/j.jccase.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/31/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
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Calvagna GM, Patanè S, Romeo P. Transcatheter pacing system and leadless defibrillator: A solution in a complex case. A case report of a patient with previous device-related infection and persistent left-sided superior vena cava. HeartRhythm Case Rep 2021; 7:12-15. [PMID: 33505847 PMCID: PMC7813789 DOI: 10.1016/j.hrcr.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Implantation of a Dual-Chamber Automatic Cardioverter Defibrillator in a Patient with Persistent Left Superior Vena Cava: Case Report and Brief Literature Review. Diagnostics (Basel) 2020; 10:diagnostics10121071. [PMID: 33322042 PMCID: PMC7763180 DOI: 10.3390/diagnostics10121071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022] Open
Abstract
Persistence of the left superior vena cava (PLSVC) is a congenital anomaly reported in 0.3–0.5% of patients. Due to the multiple and complex anatomical variations, transvenous lead placement can become challenging. We report the case of a 47-year-old patient diagnosed with non-ischemic dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF—27%), who was referred to our clinic for implantation of a dual-chamber cardioverter defibrillator for primary prevention of sudden cardiac death. During the procedure we encountered an abnormal guidewire trajectory and after venographic examination we established the diagnosis of persistent left superior vena cava. After difficult implantation of a 7F defibrillation lead through the coronary sinus, we managed to place the atrial lead through a narrow brachiocephalic vein into the right atrial appendage. In this paper, we aim to illustrate the medical and technical implications of implanting a cardioverter defibrillator in patients with PLSVC, highlighting the benefit of identifying and utilizing both the innominate vein, and the left superior vena cava and coronary sinus for placement of multiple leads, which would otherwise have been impossible.
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Technical considerations for CRT-D implantation in different varieties of persistent left superior vena cava. J Interv Card Electrophysiol 2020; 61:517-524. [DOI: 10.1007/s10840-020-00843-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
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Shafi I, Hassan AAI, Akers KG, Bashir R, Alkhouli M, Weinberger JJ, Abidov A. Clinical and procedural implications of congenital vena cava anomalies in adults: A systematic review. Int J Cardiol 2020; 315:29-35. [PMID: 32434672 DOI: 10.1016/j.ijcard.2020.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/26/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although congenital vena cava (CVC) anomalies in adults have implications for surgical and radiological interventions, the literature is scare and disparate. The aim of this systematic review was to assess cardiovascular clinical and procedural implications of CVC anomalies in adults without congenital heart disease. METHODS AND RESULTS We searched PubMed and EMBASE from database conception through October 2018 for English-language studies describing the epidemiology of CVC anomalies or their clinical or procedural implications in humans. Two independent reviewers screened 7093 records and identified 16 relevant studies. We found two major implications of CVC anomalies: 1) congenital inferior vena cava (CIVC) anomalies are associated with a 50-100-fold higher risk of deep venous thrombosis, particularly among younger patients, and 2) persistent left superior vena cava (PLSVC) is associated with a 2-3-fold higher risk of supraventricular arrhythmias. PLSVC also poses technical challenges to cardiovascular electronic device implantation, requiring alterations in surgical approach and lengthening procedure and X-ray exposure times. Due to the large disparity in reported prevalence rates of CIVC anomalies, we performed a meta-analysis of CIVC anomaly prevalence including 8 studies, which showed a weighted prevalence of 6.8% (95% CI, 4.5-9.2%). CONCLUSION These findings challenge the notion that CVC anomalies are rare and asymptomatic in adults. Rather, the literature indicates that CVC anomalies are not uncommon and have important clinical and procedural implications. To further understand the prevalence and implications of CVC anomalies, a robust US population-based study and nationwide registry is warranted in the current era of venous interventions.
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Affiliation(s)
- Irfan Shafi
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA.
| | - Abubakar A I Hassan
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | | | - Riyaz Bashir
- Department of Cardiovascular Diseases, Temple University Hospital, PA, USA
| | - Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Jarret J Weinberger
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Aiden Abidov
- Cardiology Section, John D. Dingell VA Medical Center, Detroit, MI, USA; Division of Cardiology, Wayne State University, Detroit, MI, USA
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Sato T, Ishida J, Kojima T, Komuro I. Successful Transvenous Pacemaker Implantation via Re-Directed Left Superior Vena Cava. Circ J 2019; 83:2082. [PMID: 30930426 DOI: 10.1253/circj.cj-19-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tatsuyuki Sato
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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