Key result
Persistent left superior vena cava links to ~10-minute longer pacemaker implant time without raising complications.
Why the study?
Persistent left superior vena cava (PLSVC) poses technical challenges during permanent heart rhythm device implantation, and evidence on its procedural and long-term implications remains limited.
Does persistent left superior vena cava (PLSVC) affect procedural complexity, complication rates, and long-term pacing performance in patients undergoing single-chamber permanent pacemaker implantation via the left axillary vein?
Cohort (n=250)
No
Does persistent left superior vena cava (PLSVC) affect procedural complexity, complication rates, and long-term pacing performance in patients undergoing single-chamber permanent pacemaker implantation via the left axillary vein?
Although persistent left superior vena cava increases procedural duration, fluoroscopy exposure, and contrast use during left-sided single-chamber pacemaker implantation, appropriate stylet shaping (such as an alpha-loop configuration) yields complication rates and long-term pacing thresholds comparable to normal venous anatomy.
Answers are grounded in this paper and cite their sources.
Anticipate extended procedural and radiation exposure with persistent left superior vena cava during pacemaker implantation; supports technique refinement but leaves open multicenter confirmation.
Background: Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and poses technical challenges during permanent heart rhythm device (PHRD) implantation.Evidence on its procedural and long-term implications remains limited.Aim: This study aims to compare procedural characteristics, complications, and long-term pacing performance of patients undergoing single chamber pacemaker implantation with and without PLSVC. Methods:In this retrospective single-centre study, 250 patients undergoing singlechamber permanent pacemaker implantation via the left axillary/subclavian vein were evaluated.Of these, 52 had PLSVC and 198 did not.Baseline characteristics, procedural details, complications, and follow-up outcomes were compared.Propensity score matching (PSM) was performed to adjust for baseline differences.Results: Patients with PLSVC were younger (62.0 ± 11.3 vs. 65.4 ± 10.8 years, p=0.047), with comparable comorbidities and diagnoses.Compared with non-PLSVC, patients with PLSVC had longer procedure time (41.3 ± 9.6 vs. 31.7 ± 7.3 min, p<0.001), fluoroscopy time (502.5 ± 154.8 vs. 343.7 ± 91.0 sec, p<0.001), and higher contrast use (16.4 ± 5.4 vs. 9.4 ± 3.4 mL, p<0.001).Complication rates were similar (9.6% vs. 8.6%, p>0.999).After PSM, differences in procedure time, fluoroscopy exposure, and contrast use remained significant.Median follow-up was similar in both groups (4.1 [3.9-6.3]vs 4.0 [3.8-6.9])years, p<0.001, respectively, PLSVC vs Non PLSVC groups.Conclusion: PLSVC significantly increases procedural complexity during single chamber pacemaker implantation, requiring stylet shaping, but does not adversely affect long-term outcomes.
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SHARMA et al. (2026) conducted a cohort in Single-chamber permanent pacemaker implantation with or without persistent left superior vena cava (PLSVC) (n=250). Persistent left superior vena cava (PLSVC) vs. Normal systemic venous anatomy (non-PLSVC) was evaluated on Procedure time (min) (p=<0.001). Persistent left superior vena cava increased pacemaker procedure time and fluoroscopy time without increasing complications.
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