Abstract
A 69-year-old woman was referred for upgrading implantable cardioverter defibrillator
(ICD) to cardiac resynchronization therapy defibrillator (CRT-D) because of symptomatic
heart failure due to dilated cardiomyopathy. Her electrocardiogram showed left bundle
branch block and echocardiography showed severe left ventricular dysfunction. Venography
confirmed the presence of persistent left superior vena cava (PLSVC), and occlusion
of innominate vein and the coronary sinus (CS) ostium. We tried to insert the left
ventricular (LV) lead through the PLSVC. Because the PLSVC was narrow, there was concern
that insertion of the guiding catheter through the PLSVC might cause vascular damage.
Therefore, we planned to implant the LV lead without a guiding catheter. Although
the LV lead did not advance to the CS due to the acute angle, using a second wire
(buddy wire system), the tip of the first wire was trapped by an inflated balloon
delivered by a second wire (anchor balloon technique). This technique allowed us to
reinforce the support of the other wire. The LV lead was easily advanced along with
the fixed first wire and was delivered to the lateral vein of the CS. Thus, we successfully
performed minimally invasive implantation of an LV lead through a PLSVC approach.
<Learning objective: The double wire (buddy wire) technique and anchor balloon technique are effective
options for implantation of a left ventricular lead through a persistent left superior
vena cava in cardiac resynchronization therapy.>
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiology CasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.Circ J. 2021; 85: 1104-1144
- Transvenous cardiac implantable electronic device implantation in patients with persistent left superior vena cava in a tertiary center.J Interv Card Electrophysiol. 2018; 53: 255-262
- Persistent left superior vena cava and central venous catheter position: clinical impact illustrated by four cases.Surg Radiol Anat. 2003; 25: 315-321
- New technique for superior guiding catheter support during advancement of a balloon in coronary angioplasty: the anchor technique.Catheter Cardiovasc Interv. 2003; 59: 482-488
- New bifurcation guidewire technique: a reversed guidewire technique for extremely angulated bifurcation a case report.Catheter Cardiovasc Interv. 2008; 71: 73-76
- A case of cardiac resynchronization therapy in a patient with coronary sinus ostial atresia and persistent left superior vena cava.J Cardiol Cases. 2019; 21: 101-103
- PCI techniques to aid implantation of CRT-D in a senior patient with persistent left superior vena cava.J Geriatr Cardiol. 2016; 13: 639-642
- Epicardial CRT-P- and S-ICD implantation in a young patient with persistent left superior vena cava.Herzschrittmacherther Elektrophysiol. 2016; 27: 396-398
- Comprehensive imaging review of the superior vena cava.Radiographics. 2015; 35: 1873-1892
- Reinforcement of the anchor balloon system in percutaneous coronary intervention: an in vitro assessment.Cardiovasc Interv Ther. 2021; 36: 219-225
Article info
Publication history
Published online: December 16, 2021
Accepted:
November 19,
2021
Received in revised form:
October 31,
2021
Received:
September 27,
2021
Identification
Copyright
© 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
