Implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava

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.

The incidental finding of a persistent left superior vena cava: implications for primary care providers-case and review

Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and is a persistent congenital remnant of the vena caval system from early cardiac development. Patients with congenital anomalous venous return are at increased risk of developing various cardiac arrhythmias, due to derangement of embryologic conductive tissue during the early development of the heart. Previously this discovery was commonly made during the placement of pacemakers or defibrillators for the treatment of the arrhythmias, when the operator encountered difficulty with proper lead deployment. However, in today's world of various easily obtainable imaging modalities, PLSVC is being discovered more and more by primary care providers during routine testing or screening for other ailments. Given the known association between anomalous venous return and the propensity for cardiac arrhythmias, we review the embryology of PLSVC and the mechanisms by which it leads to conduction abnormalities. We also provide the practitioner with recommendations for certain baseline cardiac observations and suggestions for proper surveillance in hopes that better understanding will reduce unnecessary and potentially harmful testing, premature subspecialty referral, and unneeded patient anxiety.

Low defibrillation threshold in a patient with a dual-coil defibrillator lead implanted through a persistent left superior vena cava

Several reports have described the successful insertion of implantable cardioverter defibrillator (ICD) in patients with a persistent left superior vena cava (PLSVC). The implanters have used various techniques to achieve appropriate lead placement. In our case, the use of a long sheath, guided by a deflectable catheter, not only facilitated proper implantation of the lead, but also provided a unique position of the dual-coil lead. This resulted in a very low defibrillation threshold (DFT). We describe a case of a patient found to have a PLSVC at implant who after successful insertion of the ICD exhibited DFT ≤ 5 J.

A novel technique for right ventricular lead placement in a patient with a persistent left superior vena cava

Persistent left superior vena cava is the most common venous anomaly of the thorax. If unrecognized, it could lead to catheter malplacement and even vascular injuries. We describe a novel use of a Worley sheath for the delivery of a right ventricular (RV) endocardial pacing lead in a 65-year-old male with a persistent left superior vena cava. After failed attempts with the standard stylets, use of the Worley sheath aided successful lead deployment. We conclude that when used appropriately, the Worley sheath is a tool that could be helpful in pacing lead placement in patients with persistent left superior vena cava.