Abstract
Persistent left superior vena cava (PLSVC) can be problematic when device implantation
is scheduled from the left side because of the technical difficulty in delivering
leads. Right-sided implantation is an alternative method, but there is a risk of a
high defibrillation threshold (DFT). Transvenous implantation of an implantable cardioverter
defibrillator (ICD) was scheduled for a 54-year-old man with idiopathic dilated cardiomyopathy
and monomorphic non-sustained ventricular tachycardia, but computed tomography revealed
the presence of a PLSVC. Right-sided ICD implantation was performed first; however,
an ICD shock at 35 J failed to terminate the induced ventricular fibrillation (VF).
Re-implantation via the PLSVC by a left subclavian approach with a dual coil lead
was performed next. The dual coil right ventricular lead was successfully implanted
via the PLSVC, and the induced VF was terminated by a single shock at 25 J. In the
present case, the proximal coil was located in the coronary sinus (CS) and it enabled
an antero-posterior defibrillation vector across the left ventricle. In addition to
the re-location of the ICD generator from the right side to the left side, the new
positioning of the proximal coil inside the CS is likely to have contributed to the
great improvement of the DFT.
<Learning objective: In cases with persistent left superior vena cava, left-sided implantationof an implantable
cardioverter defibrillator (ICD) can be problematic because of the technical difficulty,
but right-sided implantation has a risk of a high defibrillation threshold (DFT).
Leftsided ICD via the persistent left superior vena cava with a dual coil lead enables
an antero-posterior defibrillation vector across the left ventricle by positioning
of the proximal coil inside the coronary sinus and contributes to a great improvement
of the DFT.>
Keywords
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Article info
Publication history
Published online: November 22, 2021
Accepted:
October 27,
2021
Received in revised form:
September 30,
2021
Received:
June 1,
2021
Identification
Copyright
© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
