title: Epicardial CRT-P- and S-ICD Implantation in a Young Patient with Persistent Left Superior Vena Cava.
abstract: Persistent left superior vena cava is known to be a challenging anatomic abnormality for transvenous cardiac device implantation. In the a case of a young man presenting with dilative cardiomyopathy with severely impaired left ventricular ejection fraction (LVEF) and second-degree atrioventricular block (AV block), cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) implantation was indicated. A transvenous approach was attempted, but placement of the right ventricular lead was not successful due to anatomic abnormalities. Therefore, epicardial CRT leads were implanted via a left mini-thoracotomy. For primary prevention of sudden death, the patient was also fitted with an additional subcutaneous implantable cardioverter defibrillator (S-ICD). Any cross-talk between the devices was ruled out both intraoperatively and by ergometry prior to discharge. The combination of epicardial CRT-P with S‑ICD implantation might be a safe and effective alternative in patients with cardiac anatomic abnormalities.
authors.affiliation: Dep. of Cardiology, Div. of Clinical Electrophysiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: Julia W
authors.initials: JW
authors.lastname: Erath
authors.affiliation: Dep. of Cardio-Thoracic Surgery, Helios Klinikum Siegburg, Siegburg, Germany.
authors.forename: Abdul Sami
authors.initials: AS
authors.lastname: Sirat
authors.affiliation: Dep. of Cardiology, Div. of Clinical Electrophysiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: Mate
authors.initials: M
authors.lastname: Vamos
authors.affiliation: Dep. of Cardiology, Div. of Clinical Electrophysiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. hohnloser@em.uni-frankfurt.de.
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
mesh_terms: D000328:Adult; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities*
keywords: Cardiac resynchronization therapy; Defibrillators, implantable; Electrocardiography; Ergometry; Ventricular ejection fraction