Resynchronization Therapy in a Coronary Venous Sinus Anomaly

Coronary venous sinus is the major portal for cardiac venous drainage and plays a crucial role in electrophysiological procedures like left ventricular pacing. Although congenital anomalies of the coronary sinus are rare, we present a unique case of interrupted coronary sinus. The proximal segment drained normally into the right atrium, while the distal segment drained into a common channel that connected to the left subclavian vein via a persistent left superior vena cava. This anomaly was initially suspected during Levo-phase coronary sinus angiography and further confirmed by computed tomography and direct coronary sinus angiography. The patient successfully underwent implantation of a cardiac resynchronization therapydevice with right atrial and ventricular leads placed via normal superior vena cava, and the left ventricular lead placed via the persistent left superior vena cava. Understanding coronary sinus anomalies is essential for successful interventions, highlighting the importance of proper evaluation and knowledge in this field.