Key result
LV lead revision via reopened left SVC restores LVEF to ~50% after right SVC occlusion.
Why the study?
Venous occlusion after transvenous lead implantation can lead to collateral circulation, but reopening of a previously closed left superior vena cava had not been recorded in this context.
Case Report (n=1)
No
This case demonstrates that right SVC occlusion after transvenous lead implantation can cause reopening of a previously closed left SVC, through which successful LV lead revision can be achieved using standard tools.
Answers are grounded in this paper and cite their sources.
May enable alternative access in SVC occlusion; leaves open generalizability beyond this single case.
BACKGROUND: Venous occlusion is a complication of transvenous lead implantation and can lead to development of collateral circulation. Reopening of a previously closed left superior vena cava (SVC) has not been recorded in this context. CASE SUMMARY: A 71-year-old woman presented with worsening heart failure symptoms. Three years earlier, she had received a biventricular implantable cardioverter defibrillator for cardiac resynchronization therapy. During revision of a dislodged left ventricular lead, venography revealed occlusion of the right SVC and reopening of a left SVC. Despite anatomical challenges, left ventricular lead placement via the left SVC was achieved. DISCUSSION: This case highlights how obliterated venous structures can reopen after occlusion. Whereas a right-sided approach is recommended for lead placement, this case highlights a successful left SVC approach. TAKE-HOME MESSAGES: Venous occlusion is a common complication of transvenous lead implantation and can lead to collateral circulation, including left SVC reopening. Although complex, lead implantation is possible.
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Rickards et al. (2025) conducted a case report in Heart failure with reduced ejection fraction, dislodged left ventricular lead, right superior vena cava occlusion, and reopened left superior vena cava (n=1). Left ventricular lead revision via reopened left superior vena cava was evaluated on Left ventricular ejection fraction (LVEF) at 6 months. Left ventricular lead revision via a reopened left superior vena cava after right SVC occlusion succeeded without complications, improving LVEF from 30% to 50%-55% at 6 months in a 71-year-old woman.
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