Technical difficulties during electronic cardiac device implantation in patients with persistent left superior vena cava

What is it about?

We report a case of persistent left superior vena cava (PLSVC), discovered by chance during the cardiac electronic device placement procedure. PLSVCs are congenital anomalies of the thoracic vasculature, during which remnants of the left superior vena cava drain into the right atrium through the coronary sinus. PLSVCs can vary in their location and overall anatomy. In patients with PLSVC, implantation of a cardiac electronic device is associated with an increased risk of technical difficulties the entire procedure.

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Why is it important?

A typical route used for cardiac electronic device placement is an approach through the left subclavian vein. Here we seek to describe the difficulties associated with this approach in a patient with a PLSVC. PLSVCs are congenital thoracic venous anomalies present in approximately 0.3–0.5% of overall population. When the anomaly exist s veins drain into the right atrium through a connection with the coronary sinus. This is usually asymptomatic and are often incidental found during various diagnostic or therapeutic procedures. Vena subclavia approach during cardiac electronic device implantation is a good example of the latter. One of the first reports of such an incidental finding is a case documented back in 1971, describing the implantation of a single chamber pacemaker in a patient with PLSVC.