Cardiac Resynchronization Therapy in a Patient with Persistent Left Superior Vena Cava Draining into the Coronary Sinus and Absent Innominate Vein: A Case Report and Review of Literature

Active fixation coronary sinus lead in a patient with persistence of left superior vena cava

In patients with PLSVC, the use of an active fixation lead (like the Medtronic "Attain Stability") on the coronary sinus can lead to a successful and safe cardiac resynchronization, facilitating its positioning with a low long-term displacement rate.

Cardiac implantable electronic devices in patients with persistent left superior vena cava-A single center experience

BACKGROUND

There are limited data on cardiac implantable electronic device implantation (CIED) in patients with persistent left superior vena cava (PLSVC).

OBJECTIVE

To describe the outcomes of implanting CIEDs with a focus on cardiac resynchronization therapy (CRT) in patients with PLSVC.

METHODS

We identified all patients with a PLSVC that underwent CIED implantation from December 2008 until February 2019 at our institution by querying the electronic medical record (n = 34). We then identified controls in a 3:1 fashion (n = 102) by matching on device type (CRT vs non-CRT). Procedure success, complications, fluoroscopy and procedural time were recorded. Outcomes were compared using a two-way analysis of variance test and conditional regression modeling for continuous and categorical variables, respectively.

RESULTS

A total of 34 patients with PLSVC underwent 38 procedures. Four patients underwent dual chamber system implantation followed by a subsequent upgrade to CRT. Thirteen patients underwent CRT implantation: one was implanted via the right subclavian while the rest were implanted via the PLSVC. Left ventricular (P = .06). Procedure and fluoroscopy times were significantly higher in the PLSVC as compared with the control group (97.7 vs 66.1 minute, P < .001 and 18.1 minute vs 8.7 minutes, P = .005, respectively).

CONCLUSION

CIED implant in patients with PLSVC is feasible but technically more challenging and appears to be associated with higher risk of right ventricular lead dislodgment.