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. 2021 Aug 5;37(5):1364-1367.
doi: 10.1002/joa3.12613. eCollection 2021 Oct.

Combined therapy with subcutaneous implantable cardiac defibrillator and leadless pacemaker in a patient with persistent left superior vena cava and mega coronary sinus: A challenging case for the best treatment

Maria Chiara Gatto  1 , Valerio De Sanctis  2 , Francesca Percoco  1 , Alessandro Persi  1 , Tania Dominici  1 , Andrea Moretti  1 , Franco Evangelista  1 , Massimo Mantica  2 , Amir Kol  1
Affiliations

Combined therapy with subcutaneous implantable cardiac defibrillator and leadless pacemaker in a patient with persistent left superior vena cava and mega coronary sinus: A challenging case for the best treatment

Maria Chiara Gatto et al. J Arrhythm. .

Abstract

In a patient requiring pacing and defibrillation therapy, but without superior venous access, combined therapy with S-ICD and leadless pacemaker could be the best solution. An appropriate programming of both devices represents the technical challenge in order to avoid inappropriate shocks due to leadless pacing oversensing.

Keywords: combined therapy; device programming; leadless pacemaker; persistent left superior vena cava; subcutaneous implantable cardiac defibrillator.

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Conflict of interest statement

Authors did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors. Data are available upon request from the corresponding author.The authors declare no conflict of interests for this article.

Figures

FIGURE 1
FIGURE 1
Echocardiography showing mega‐coronary sinus entering the right atrium (A); Symptomatic bradycardia (B) and ventricular tachycardia with HR 130 bpm (C) recorded on monitor. LV, left ventricle; MCS, mega‐coronary sinus; RA, right atrium; RV, right ventricle. Inter‐beat intervals are expressed in milliseconds
FIGURE 2
FIGURE 2
Venography from the right superior arm, with guidewire advanced from the left subclavian vein, showing the absence of right superior vena cava and the presence of persistent left superior vena cava (A) draining in the mega coronary sinus (B: dashed white line)
FIGURE 3
FIGURE 3
Leadless pacemaker implantation; on the left of the delivery system, in the middle of the image, in parasternal position, is the defibrillator lead of S‐ICD system (A); definitive antero‐posterior chest X‐ray showing position of both devices (B). Spontaneous sensed beats by S‐ICD (from top to the bottom primary, secondary and alternative vector) (C); Paced sensed beats by S‐ICD (from top to the bottom primary, secondary and alternative vector) (D)
See this image and copyright information in PMC

References

    1. J Arrhythm. 2021 Aug 05;37(5):1364-1367 - PubMed