title: Innovative endovascular defibrillator lead use in superior vena cava obstruction.
abstract: BACKGROUND
  We describe an unusual case of severe heart failure (HF) and rapid atrial fibrillation (AF) improved through ablation and pacemaker implant despite superior vena cava obstruction (SVCO).
  
  
  METHODS
  SVCO precluded upper body venous access to the heart for procedural rate control. Both AV Junctional ablation and permanent endovascular lead placement were achieved through the inferior vena cava (IVC).
  
  
  RESULTS
  Clinical improvement from NYHA Class IV to Class II HF was observed with effective nonpharmacologic ventricular rate control.
  
  
  CONCLUSIONS
  HF patients with rapid AF and SVCO can achieve ventricular rate control through lower body venous access to the heart utilizing 100-cm endovascular defibrillator rate sensing leads.
authors.affiliation: Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794, USA.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Stys
authors.forename: Shalini
authors.initials: S
authors.lastname: Kapoor
authors.forename: Danielle
authors.initials: D
authors.lastname: Carter-Adkins
authors.forename: Roman T
authors.initials: RT
authors.lastname: Pachulski
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012720:Severity of Illness Index; D013479:Superior Vena Cava Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome