Project description:BackgroundCongenital absence of superior vena cava (CASVC) is an extremely rare vascular anomaly often associated with conduction disturbances which makes implantation of a pacemaker difficult. We report a case of pacemaker implantation in a patient presenting with complete atrioventricular block (c-AVB) with bilateral absence of the SVC.Case summaryA 68-year-old man who had experienced dyspnoea on exertion by c-AVB was admitted to our hospital for treatment and management. Permanent pacemaker insertion was initially planned; however, an endocardial pacemaker lead could not be implanted in the right atrium. Computed tomography scan with contrast revealed that the venous blood from the upper half of the body flowed into the inferior vena cava via the azygos vein. Due to the difficulty of inserting an endocardial lead from the subclavian vein, a leadless pacemaker (LP) was implanted instead via the femoral vein.DiscussionThis is the first case of an LP implantation in a patient presenting with c-AVB with CASVC. Confirmation of blood vessel anatomy to rule out CASVC is necessary prior to pacemaker implantation when abnormal venous anatomy is suspected.

| S-EPMC8189307 | biostudies-literature

Pacemaker Placement in Persistent Left Superior Vena Cava.

Project description:Persistent left superior vena cava (PLSVC) is a rare disorder which is asymptomatic and hence is usually discovered while performing interventions through the left subclavian vein. We present a case of a 78-year-old male who was undergoing elective placement of a permanent pacemaker for tachycardia - bradycardia syndrome with post-conversion pauses of up to nine seconds. After achieving access through the left subclavian vein the wire kept on going on the left side of the chest instead of crossing the midline to the right side. The wire was removed and contrast venography was done, PLSVC with dilated coronary sinus emptying into the right atrium was confirmed. There was some difficulty in passing the lead to the right ventricle even with the acute curve in the stylet. The sheath size was increased and a longer deflectable sheath was used and with the tip of the lead anteriorly the right ventricle was cannulated and the lead was affixed. There were good sensing and pacing parameters. Post procedure chest x-ray was done and the patient was discharged without any complications.

| S-EPMC5498123 | biostudies-other

Venous bifurcation stenting for pacemaker-induced superior vena cava syndrome.

Project description: Not available

| S-EPMC8307697 | biostudies-literature

Multiple images of pacemaker-related endocarditis and superior vena cava syndrome

Project description: Not available

| S-EPMC5368535 | biostudies-literature

Ablation of atrioventricular-nodal-reentrant- tachycardia in a patient with left-sided superior vena cava and dilated coronary sinus.

Project description:Atrioventricular (AV)-nodal-reentrant-tachycardia is a rare association in a patient with persistent left-sided superior vena cava and dilated coronary sinus. There are a few inherent difficulties in ablation in this condition, viz., difficulty in localization of good site for ablation and difficulty in stabilization of the ablation catheter at the designated site, making it difficult to produce transmural lesions and increasing risk of producing AV block. We hereby present a case highlighting the difficulties and possible solutions for them.

| S-EPMC7542059 | biostudies-literature

An Ectopic Primary Pacemaker in Association with Isolated Persistent Left Superior Vena Cava.

Project description:We are reporting a case of a young Nepalese man, who was not known to have any past medical history, and who presented with palpitations. An electrocardiogram showed negative P-waves atrial rhythm in II, III, arteriovenous fistula, and V3-V6 with a variable block at 90-130 bpm. No positive "normal" P-waves were demonstrated in any tracing. He was found to have a congenital absence of the right superior vena cava (RSVC) along with persistent left superior vena cava (PLSVC) a condition also called isolated PLSVC (IPLSC). He underwent a treadmill stress test for further evaluation which showed a normal chronotropic response and the same persistent negative P-waves morphology. An invasive electroanatomical and activation mapping showed an absence of RSVC, the earliest atrial activation site in the anterior side of the inferior vena cava (IVC), and the absence of normal (positive) P-waves/normal sinus node (SN) activation. Considering all the available clinical data together, we believe that the patient was living with an ectopic pacemaker node that acts as a primary node and originated in the IVC/right atrium instead of the normal expected SN position. Given the high risk of complete sinoatrial nodal block in case of radiofrequency ablation, the patient was kept on medical treatment with a beta-blocker which was effective in controlling his symptoms and atrial arrhythmia.

| S-EPMC9542964 | biostudies-literature

A case report of simultaneous His pacemaker implantation and atrioventricular junction ablation following unsuccessful treatment of atrial fibrillation.

Project description:BackgroundAtrial fibrillation can contribute to heart failure. Frequently, rhythm control is unachievable. Atrioventricular (AV) junction ablation and pacemaker implantation remain to be a therapeutic option for rate control in atrial fibrillation. Interventricular asynchrony is a potential downside of right ventricular pacing. However, cardiac resynchronization therapy and His pacing restore physiological activation sequences of the ventricles.Case summaryThe reported patient had undergone several interventions to cure atrial fibrillation without sufficient rhythm control and experienced deleterious effects of recurrent arrhythmias. Finally, we decided to ablate the AV junction simultaneously with the implantation of a His bundle pacemaker. Atrioventricular junction ablation had to be repeated following conduction recurrence. A left-sided transaortic approach was required to create a permanent effect and to avoid distal lesions. His pacing was not affected by the AV junction ablation at all. The pre-existing widened QRS was normalized by His pacing, the patient became free of any complaints with full restoration of exertion capability.DiscussionHis pacing has the potential to contribute to a revival of the 'ablate-and-pace' concept for incurable atrial fibrillation by restoring physiological ventricular activation, thereby overcoming the particular drawbacks of continuous ventricular pacing. Atrioventricular junction ablation simultaneously with the pacemaker implantation procedure is safe and feasible. His pacing is at least an alternative for cardiac resynchronization therapy. The implantation procedure is sometimes challenging.

| S-EPMC7501939 | biostudies-literature

Radiofrequency catheter ablation in a patient with dextrocardia, persistent left superior vena cava, and atrioventricular nodal reentrant tachycardia: A case report.

Project description:RationaleDextrocardia is a rare congenital heart disease, while the persistent left superior vena cava (PLSVC) is an uncommon congenital vascular malformation. It is extremely rare for a person to have dextrocardia and PLSVC. A case with a combination of dextrocardia, PLSVC, and atrioventricular nodal reentrant tachycardia has not been reported.Patient concernsA 51-year-old woman was admitted to the hospital with palpitations. The physical examination revealed a heart rate of patient increased significantly, and that apex beating was found in the right fifth intercostal space approximately 0.5 cm from the midclavicular line.DiagnosisWe used different techniques, including electrocardiography, esophagus heart electrophysiology, chest radiograph, and cardiac color Doppler echocardiography to reveal the presence of the combination of dextrocardia, PLSVC, and supraventricular tachycardia.InterventionsWe terminated tachycardia by esophageal pacing and cured patients with radiofrequency catheter ablation (RFCA).OutcomesThe complex structural anomalies presented great technical challenges for interventional treatments. After consulting the literature, thorough examination and understanding of the structural anatomy and anomalies of the vena cava and cardiac chambers, we successfully treated this patient by RFCA. After half a year of follow-up, the patient did not have palpitations, and no arrhythmia was seen on the electrocardiography.LessonsPhysicians need to be aware that the key to the success of RFCA, in this case, is to clarify the complexity of the morphological and anatomical structures of dextrocardia accompanying PLSVC and to consult and understand the experience of access vessels reported in relevant cases before the operation.

| S-EPMC7478451 | biostudies-literature

Implantation of VVI pacemaker in a patient with dextrocardia, persistent left superior vena cava, and sick sinus syndrome: A case report.

Project description:BackgroundDextrocardia, or right-lying heart, is an uncommon congenital heart disease in which the apex of the heart is located on the right side of chest. Persistent left superior vena cava (PLSVA) is a rare venous anomaly that is often associated with the abnormalities of cardiac transduction system. A case with combination of dextrocardia, persistent left superior vena cava, and sick sinus syndrome has not been reported.MethodsWe used different techniques including cardiac color Doppler echocardiography, 24-hour Holter monitoring, and abdominal ultrasound to make a diagnosis and treated the patient by implanting a VVI pacemaker.ResultsA 50-year-old woman was admitted with a syncope. Angiography of the right atrium and superior vena cava, echocardiography, electrocardiography, and abdominal ultrasound revealed the presence of the combination of mirror image dextrocardia, PLSVA, and sick sinus syndrome. The complex structural anomalies presented great technical challenges for interventional treatments. After thorough examination and understanding of the structural anatomy and anomalies of the superior and inferior vena cava and cardiac chambers, we successfully treated this patient by implanting a VVI pacemaker.ConclusionPhysicians must be aware of the complexity of the morphological and anatomical structures of dextrocardia accompanying PLSVC. Given that the diagnosis of situs inversus was performed at a relatively advanced age, it is therefore important to make such a correct diagnosis followed by appropriate therapeutic intervention.

| S-EPMC5293471 | biostudies-literature

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