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. 2022 Mar 21;38(3):488-490.
doi: 10.1002/joa3.12699. eCollection 2022 Jun.

Active fixation of bipolar left ventricular lead through a persistent left superior vena cava

Daniele Nicolis  1 , Giacomo Mugnai  2 , Patrizia Pepi  1 , Flavio Luciano Ribichini  2 , Corrado Lettieri  1
Affiliations

Active fixation of bipolar left ventricular lead through a persistent left superior vena cava

Daniele Nicolis et al. J Arrhythm. .

Abstract

A left superior vena cava persistence was found in a 61 year-old patient affected by dilated and hypokinetic cardiopathy with severe dysfunction of the left ventricle (left ventricular ejection fraction of 32%) and valvular disease. After a negative coronary angiography, he was implanted with a cardiac resynchronization therapy with defibrillation function device (CRT-D). The present case describes the successful implantation of a biventricular defibrillator in this challenging congenital abnormality of cardiac venous system.

Keywords: biventricular; cardiac resynchronization; defibrillator; persistent left superior vena cava.

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Conflict of interest statement

No conflict of interest to be declared.

Figures

FIGURE 1
FIGURE 1
Persistence of left‐sided superior vena cava shown by contrast dye injection and abnormal course of the guidewire
FIGURE 2
FIGURE 2
(A) Right ventricular lead positioning (Right anterior oblique [RAO] 30° fluoroscopy). (B) Right atrial lead positioning (RAO 30° fluoroscopy). A decapolar electrophysiology catheter can be noticed; this catheter has been used as a reference point for tricuspid valve making the defibrillation lead placement easier
FIGURE 3
FIGURE 3
(A) Contrast dye fluorography highlighting the coronary sinus directly draining into the left superior vena cava. (B) Left ventricular lead positioning inside an antero‐lateral coronary sinus branch (Right anterior oblique 30° fluoroscopy). (C) The picture clearly shows the active fixation bipolar left ventricular lead and the marker behind the dipole which represents the active fixation helix (LAO 30° fluoroscopy)
FIGURE 4
FIGURE 4
(A) Electrocardiogram (ECG) before the cardiac resynchronization therapy with defibrillation function device (CRT‐D) implantation showing normal sinus rhythm and left bundle branch block (QRS duration: 130 ms). (B) ECG following CRT‐D implantation showing normal sinus rhythm and biventricular pacing with a QRS duration of 110 ms
See this image and copyright information in PMC

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