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Case Reports
. 2023 Aug 14;17(1):346.
doi: 10.1186/s13256-023-04073-y.

Slittable sheath supported right ventricular pacing lead implantation in persistent left superior vena cava with absent right superior vena cava: a case report

Jiří Plášek  1   2   3 , Jiří Vrtal  4 , David Šipula  4 , Tomáš Grézl  4 , Jan Václavík  4   5
Affiliations
Case Reports

Slittable sheath supported right ventricular pacing lead implantation in persistent left superior vena cava with absent right superior vena cava: a case report

Jiří Plášek et al. J Med Case Rep. .

Abstract

Background: Persistent left superior vena cava (PLSVC) is the most common variant of systemic venous drainage. In the absence of the right superior vena cava (RSVC), implantation of a right ventricular pacing lead may be challenging. Therefore specific implantation techniques and experiences in PLSVC are worth reporting.

Case presentation: We present a case report of a 90-year-old Caucasian female patient with PLSVC during single chamber pacemaker implantation due to the third-degree atrioventricular block. With common implantation techniques, we did not even reach the right ventricle. Therefore slittable CPS Direct ™ Universal sheath was employed to overcome the acute angle from PLSVC to tricuspid valve and ensure more fixation stability for longer 100-cm right ventricular lead placement.

Conclusion: This case demonstrates safe implantation of 100-cm long right ventricular bipolar active fixation pacing lead using common slittable CPS Direct ™ Universal sheath after failed attempts with "C" and "J" stylet shaped electrode. This sheath provides different angle towards tricuspid valve and more fixation stability in patient with PLSVC and absent connection to right atrium.

Keywords: Cardiac pacing; PLSVC; Persistent left superior vena cava; RSVC; Right superior vena cava; Slittable sheath.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Chest X-ray. A posteroanterior projection; contrast visualization of persistent left superior vena cava (arrow); B posteroanterior projection; contrast visualization of absent right superior vena cava, subclavian vein draining into the azygous vein; right anterior oblique projection of cardiac pacing lead (arrow); D left anterior oblique projection of cardiac pacing lead in „alpha “ loop contouring the shape of coronary sinus
Fig. 2
Fig. 2
Illustration depicting the route of right ventricular pacing lead through persistent left superior vena cava
See this image and copyright information in PMC

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