Transvenous pacing in complex post-operative congenital heart disease guided by angiography: A case report

Fig. 1. A) SVC angiography demonstrating the IVC to the left of the spine and also the major cardiac silhouette to the left of the spine indicating abdominal situs inversus and levocardia. The venous blood drains to the morphologic left atrium (MLA). B) Angiography reveals the acute angulation of the baffle crossing the spine from left to right to enter the morphological left atrium with the absence of atrial appendage as depicted in the cartoon E. C) morphological left atrium is connected to the morphological right ventricle (MRV) which drains into the pulmonary artery as depicted in cartoon E. D) shows levophase of the angiogram demonstrating the morphological right atrium (MRA) draining into smooth-walled morphologic left ventricle (MLV) as depicted in the cartoon F.

Fig. 2. A) and B) the course of the renal catheter through the complicated route in to the right ventricle in AP view, C) and D) shows LAO and shallow RAO views demonstrating the ventricular lead in the mid-septal position in the right ventricle and the atrial lead in the venous atrium. The tortuosity and the complex course taken by the leads can be appreciated.

Fig. 3. The 12-lead electrocardiogram of patient after dual chamber pacemaker implantation shows atrial sensed ventricular paced beats. The P-wave in lead I is inverted (red arrow heads) indicating atrial situs inversus. The QRS complex in lead I is upright with left bundle and left axis configuration with normal QRS progression in the chest leads preceded by a pacing spike (black arrows) in lead II indicating right ventricular apical pacing. The normal progression of QRS in the chest leads and upright QRS with leftward axis indicates levocardia.