CRT-D Upgrading in a Patient with Persistent Left Superior Vena Cava and Right Superior Vena Cava Atresia Using the Novel Active-Fixation Quadripolar Left Ventricular Lead

Sergio Conti,Vito Bonomo,Umberto Giordano,Giuseppe Sgarito,Antonio Taormina

doi:10.4236/wjcd.2018.89045

Abstract

The persistence of left superior vena cava (PLSVC) is the most common congenital anomaly of the venous return system to the heart. Because of the increasing number of patients referred for cardiac resynchronization therapy (CRT) devices implantations, it is expected to encounter this venous anatomic variation. Left ventricular lead placement at an appropriate site is an integral and technically challenging part of successful CRT. In case of cardiac abnormalities could be difficult to achieve an optimal cardiac rhythm management devices implantation. Previous reports in patients with PLSVC highlighted the challenges to achieve an optimal cardiac rhythm device implantation. Recently, a new quadripolar active fixation left ventricular lead is available for CRT device implantation. Hereby we report a case of a device upgrading from dual-chamber pacemaker to CRT with defibrillator backup using the active fixation left ventricular quadripolar lead in a patient with PLSVC and right superior vena cava atresia.

Highlights

Because of the increasing number of patients referred for cardiac resynchronization therapy (CRT) devices implantations, it is expected to encounter this venous anatomic variation
Hereby we report a case of a device upgrading from dual-chamber pacemaker to CRT with defibrillator backup using the active fixation left ventricular quadripolar lead in a patient with persistence of left superior vena cava (PLSVC) and right superior vena cava atresia
A 77-year-old man suffering from congestive heart failure (NYHA class II) and post-ischemic dilated cardiomyopathy was referred to our Centre for an upgrading to a cardiac resynchronization therapy device with defibrillator backup (CRT-D)

Summary

Introduction

Previous reports of cardiac rhythm device implantation in patients with PLSVC highlighted the challenges to achieve a stable of the leads inside the heart chambers. Improvements in materials and techniques over the years allowed the successful implantation of cardiac rhythm management devices including CRT devices even in case of unfavorable anatomies. A new quadripolar active fixation left ventricular lead has been developed and available for CRT device implantation. This new technology combines the advantages of the multipolar technology and the stability of the active fixation leads and it allows a more precise and stable lead placement, helpful in case of abnormal or unfavorable anatomy of the coronary sinus

Case Report

Findings

Discussion

Conclusion