Transvenous defibrillator implantation in a patient with persistent left superior vena cava

An Innovation in Pacemaker Lead Implantation via Persistent Left Superior Vena Cava: The "3D Alpha Curve" Stylet

Persistent left superior vena cava (PLSVC) draining into coronary sinus is typically detected incidentally during transcatheter interventions using left subclavian venous approach. In our experience, we have encountered this anomaly on a few occasions and in all these cases we successfully implanted leads in the right ventricle (RV) by shaping the stylet into a "U-shaped" or "pigtail-shaped" curve. Herein, we report a case of an adult male who underwent successful dual-chamber pacemaker implantation via PLSVC through left axillary venous approach. In this case, we were unable to deliver the lead into RV using aforementioned stylets. As an innovation, we used a "three-dimensional alpha curve"-shaped stylet that facilitated an easy entry of pacing lead into the RV.

Persistent left superior vena cava and pacemaker implantation

Our study group read with interest the paper from Vijayvergiya et al describing the implantation of an implantable cardioverter-defibrillator lead in the presence of the persistence of the left superior vena cava. The issue of the identification a persistent left superior vena cava is of paramount importance in interventional cardiology, being the most common venous anomaly of the thoracic distribution, and because it may create some problem to any physician while performing a pacemaker lead implantation. In our letter we underscore the specific issues related to pacemaker implantation while encountering a persistent left superior vena cava (and maybe the absence of the right vena cava) and the workup that should be performed to obtain the preoperative diagnosis of the venous anomaly. More specifically, we consider avoiding any kind of defibrillator lead implantation through the coronary sinus for safety issues, and underscore the straightforward transthoracic ultrasound approach to identify the left superior vena cava.