Surgical Epicardial CRT-D Implantation in a Patient with Complete Obstruction of the Superior Vena Cava

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  Figure 1. A) 12-lead ECG before epicardial CRT-D implantation: sinus P waves with dissociated right ventricular epicardial pacing; B) 12-lead ECG after epicardial CRT-D implantation: sequential atrial pacing and biventricular pacing. C) Chest x ray before epicardial CRT-D implantation: 1 Abandoned endocavitary right atrial lead; 2- Abandoned endocavitary right ventricular pacing/defibrillator lead; 3- Abandoned endocavitary left ventricular lead; 4 - Epicardial mono-chamber pacemaker generator; 5 - Epicardial mono-chamber pacemaker lead. D) Intra operatory situs after lead implantation: 1 - Epicardial right atrial lead; 2 - Epicardial right ventricular outflow tract lead; 3- Left ventricular lateral lead; 4- Epicardial anterior defibrillator patch; 5- Epicardial posterior defibrillator patch. E) Intra operatory situs showing lead tunneling to left sided pre pectoral pocket. F) Chest x ray after epicardial CRT-D implantation: 1 Abandoned endocavitary right atrial lead; 2 - Abandoned endocavitary right ventricular pacing/defibrillator lead; 3 - Abandoned endocavitary left ventricular lead; 4 - Epicardial right atrial lead; 5 - Epicardial right ventricular outflow tract lead; 6- Left…