571 SUCCESSFUL PERMANENT PACEMAKER IMPLANTATION IN A PATIENT WITH DEXTROCARDIA AND SITUS INVERSUS TOTALIS: LOOKING AT THE MIRROR.

Abstract Background Dextrocardia is a rare congenital condition with prevalence of 0.83 per 10000 pregnancies. Its most common configuration situs inversus totalis, also known as “mirror-image dextrocardia”. This case report presents clinical symptomatic sinus node dysfunction requiring permanent pacemaker implantation (PPI) in patient mirror-image dextrocardia. Case summary A 81-year-old female totalis presented recurrent syncope. Sick syndrome was diagnosed after documentation critical pauses (>6.3”) at 24-hour Holter monitoring, giving indication to elective PPI. At admission, 12-lead ECG showed bradycardia and right axis deviation on the frontal plane (standard peripheral leads position precordial side chest). Transthoracic echocardiography performed prior procedure ultrasound probe flipped placed patient's thorax, thus achieving standard windows images. preserved biventricular systolic function absence relevant valvular disease or cardiac malformations documented. The next day, dual-chamber implanted following technique operator standing subclavian vein puncture; pocket created pectoral region. entire under fluoroscopic guidance using horizontally 180° views, therefore obtaining identical images those PPI procedures, helping identify anatomical structures during lead positioning. [Fig. 1 - b] Chest X-ray confirmed correct placement procedure-related complications. Stable satisfactory parameters were observed follow-up. Discussion In literature there are only few reports totalis. symmetrical disposition anatomy makes transvenous technically demanding. this challenge overcome by fluoroscopy images, facilitate positioning maneuvres. can be considered not other forms dextrocardia, such dextroversion destroposition, because it situation which mirror image normal one.