Cardiac Implantable Electronic Devices in Different Anatomical Types of Persistent Left Superior Vena Cava: Case Series and Brief Review of the Literature

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Persistent left superior vena cava (PLSVC) in patients requiring cardiac implantable electronic devices (n=4). Intervention: Cardiac implantable electronic device (pacemaker or ICD) implantation via adapted transvenous technique. Primary outcome: Successful lead placement with adequate device parameters (sensing, pacing, and impedance) at implant, 1, 6, and 12 months.

Q: What does this research mean for the field?

Cardiac implantable electronic device implantation can be successfully and safely performed across diverse anatomical variants of persistent left superior vena cava by adapting transvenous lead placement techniques. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Cosmin Gabriel Adavidoaei; Ana Maria Haba; Irina Iuliana Costache; Mihai Ștefan Cristian Haba; Ciprian Rezuș; Andreea Maria Ursaru; Dan Tesloianu

doi:10.3390/diagnostics12112596

October 26, 2022DiagnosticsOpen Access

Cardiac Implantable Electronic Devices in Different Anatomical Types of Persistent Left Superior Vena Cava: Case Series and Brief Review of the Literature

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Key result

Adapted transvenous CIED implantation achieves 100% success with stable 12-month parameters in persistent left SVC.

n=4

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Why the study?

The clinical significance and technical difficulties of persistent left superior vena cava (PLSVC) during cardiac device implantation depend on anatomical drainage variants, posing procedural challenges.

Key Points

Describe the procedural challenges and technical modifications required during cardiac pacemaker or cardioverter defibrillator implantation in patients with anatomical variations of persistent left superior vena cava.
Evaluated vascular anatomy and drainage variants intraprocedurally using venous angiography and echocardiography.
Techniques were tailored in all cases to manage vascular access and prevent complications, primarily the improper placement of the right ventricular lead within the coronary sinus.

Study Design

Type

Case Report (n=4)

Multicenter

No

Structured PICO

P

Population

4 patients (aged 60-69 years, 50% female; out of 6 total PLSVC cases identified among 4,000 device recipients) with persistent left superior vena cava undergoing pacemaker or ICD implantation, followed for 12 months.

I

Intervention

Cardiac pacemaker (CP) or cardioverter defibrillator (ICD) implantation with technique adapted to patient anatomy

O

Outcome

Technical difficulties and adaptation of implantation technique

Limitations

Single-center retrospective case series with a small sample size (6 total PLSVC cases, 4 newly reported)
Intraprocedural venography does not allow differentiation between Schummer type II and type IIIB PLSVC without post-procedural CT imaging

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Implication

PLSVC is a rare congenital anomaly encountered during CIED implantation that requires specific technical adaptations to ensure proper lead placement and avoid complications.

Abstract

Persistent left superior vena cava (PLSVC) is the most common congenital malformation of the thoracic venous system, being present in 0.3% to 0.5% of the general population. In the majority of the cases, PLSVC is asymptomatic, but in certain patients, it can manifest through several symptoms, such as arrhythmias and cyanosis, especially when it is associated with complex cardiac pathologies. The clinical significance of this venous anomaly depends on the anatomical variant of the drainage site. In this article, we will present the experience of our clinic, with patients with PLSVC that were diagnosed intraprocedurally, during cardiac pacemaker (CP) or cardioverter defibrillator (ICD) implantation, highlighting the technical difficulties that this anomaly poses for cardiac device implantation. Out of 4000 patients who were admitted to our clinic for CP or ICD implantation, we encountered six cases of PLSVC (four reported in this article and two previously published) corresponding to different anatomical types of this congenital anomaly. In all of these situations, we had to adapt our technique to the patient's anatomy in order to avoid certain complications, the most serious being the improper placement of the right ventricle lead at the level of the coronary sinus.

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Cite This Study

Adavidoaei et al. (2022) conducted a case report in Persistent left superior vena cava (PLSVC) in patients requiring cardiac implantable electronic devices (n=4). Cardiac implantable electronic device (pacemaker or ICD) implantation via adapted transvenous technique was evaluated on Successful lead placement with adequate device parameters (sensing, pacing, and impedance) at implant, 1, 6, and 12 months. Cardiac implantable electronic device implantation using adapted transvenous techniques achieved 100% procedural success and stable 12-month lead parameters in 6 patients with PLSVC.

synapsesocial.com/papers/6a8b1a2b039371f2a3894125 https://doi.org/10.3390/diagnostics12112596

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Cardiac Implantable Electronic Devices in Different Anatomical Types of Persistent Left Superior Vena Cava: Case Series and Brief Review of the Literature

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiac Implantable Electronic Devices in Different Anatomical Types of Persistent Left Superior Vena Cava: Case Series and Brief Review of the Literature

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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