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The persistence of a left superior vena cava (LSVC)
has been reported to occur approximately in 0.5% of the general population, and is a relevant
anatomical finding in adult population when a left superior access to the heart is considered.
In fact, it can complicate proper positioning of pacemaker (PM) and cardioverter-defibrillator
(CD) leads.
In this study we observed the prevalence of LSVC in a population of patients undergoing
pacemaker or transvenous cardioverter defibrillator. By left cephalic/left subclavian approach
to the heart LSVC persistence is easily diagnosed during lead placement.
RESULTS. Among 1139 consecutive patients undergoing PM implantation, 4 LSCV
(0.34%) were observed; 2 LSVC among 115 patients (1.7%) undergoing CD implantation
were also observed. Overall LSVC persistence was found in 6/1254 (0.47%) patients.
Among PM patients, 2 received a left-sided implantation (active fixation leads in both),
whereas 2 received an elective right-sided implantation.
Among CD patients, the first received a regular left-sided active-can device, with a
standard lead; the second also received a left-sided device, but with a right-sided lead
tunnelled to the left pectoral pocket due to poor catheter handling through the coronary sinus.
Long term follow-up of these patients (average 18±13 months) revealed absence of lead
dislodgement and proper function either for PM or CD patients regardless of lead
implantation site.
Persistence of LSVC in an adult population undergoing PM/CD implantation is similar to
general population, and may cause technical problems during lead placement; however,
this task can be accomplished by careful wire handling and by use of active fixation leads
in most of cases, with excellent outcome at short term and appropriate device performance
at follow-up.
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