How many leads through persistent left superior vein cava and coronary sinus?
In the modern implanting era with progressive expanding indications to resynchronization therapy, upgrading procedure is a relatively common event. Persistent left superior vena cava (PLSVC), the most common venous abnormality, may exacerbate technical difficulties. We describe the procedure of upgrading from a dual chamber pacemaker to resynchronization/defibrillation system with a total of 4 leads through a PLSVC entering a dilated coronary sinus (CS) never described before. The case report, in addition to the description of a unique technical approach, raises a lot of clinical questions about how many leads we can introduce in such a venous structure and inside CS without hemodynamic impact on venous drainage potentially leading to life-threatening situations.
Division of Cardiology, University of Verona, Verona, Italy. giovanni.morani@azosp.vr.it
Giovanni
G
Morani
Corinna
C
Bergamini
Mauro
M
Toniolo
Corrado
C
Vassanelli
D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000517:prevention & control*; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus / Q000002:abnormalities* / Q000601:surgery; D004567:Electrodes, Implanted; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000601:surgery