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A case report: upgrade to cardiac resynchronization therapy with a blocked persistent left-sided superior vena cava.

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journal contribution
posted on 19.11.2020, 16:15 by Kawan Fadhil Abdalwahid, Gavin S Chu, William B Nicolson
Background :Pacemaker-induced cardiomyopathy (PICM) can occur in up to 9% of patients having a pacemaker. Pacemaker-induced cardiomyopathy can be treated by upgrade to a biventricular pacemaker with a left ventricular (LV) lead implantation. The procedure can be technically challenging in patients with persistent left-sided superior vena cava (PLSVC). Case summary :We report the case of a 72-year-old gentleman with a PLSVC, who had a dual-chamber pacemaker implanted 15 years ago for complete heart block. After 12 years of good health, the gentleman developed breathlessness due to PICM. At upgrade to biventricular pacemaker, his coronary sinus was found to be occluded and a collateral branch was used to successfully position an LV lead. Marked clinical improvement was seen before representation with syncope after 2 years due to simultaneous failure of both LV and right ventricular leads. Subsequently, a right-sided de novo biventricular pacemaker was implanted. In this instance, the PLSVC was beneficial because it isolated the existing leads from the new implant, thereby reducing the risk of SVC obstruction. Discussion :Although implantation of pacemaker leads through a PLSVC constitutes a challenging procedure due to manoeuvring difficulties of the pacing leads into the cardiac chambers, in this particular case, the presence of PLSVC was beneficial because it meant that no leads were present in the true SVC, reducing the risk of occlusion and avoiding the need for lead extraction.

History

Citation

European Heart Journal - Case Reports, Volume 4, Issue 2, June 2020, Pages 1–5, https://doi.org/10.1093/ehjcr/ytaa015

Author affiliation

Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

European heart journal. Case reports

Volume

4

Issue

2

Pagination

1 - 5

Publisher

Oxford University Press (OUP)

issn

2514-2119

eissn

2514-2119

Acceptance date

16/01/2020

Copyright date

2020

Available date

21/02/2020

Spatial coverage

England

Language

eng