An alternative approach for endocardial pacemaker lead implantation in patient with persistent left superior vena cava.

INTRODUCTION Persistent left superior vena cava represents a congenital vascular defect of the venous system, which often makes standard 58 cm endocardial lead placement impossible. CASE OUTLINE A right chamber approach by the left cephalic vein was tried. This was impossible because standard endocardial lead (SJM Isoflex 5 1646T, bipolar lead, 58 cm in length, body diameter 7 French) was too short for this patient. A unipolar lead for coronary sinus (Medtronic ATTEIN 4193-88), 88 cm in length, body diameter 4 French, was placed in the posterior branch of the coronary sinus. With such positioning of the lead, a VVI pacemaker pacing was enabled. The operation lasted for 48 minutes, and the time of total X-ray exposure was 9.6 minutes. The values that were achieved were: threshold 0.3 V, pulse width 0.37 ms, maximum R 22.55 mV. Ten months after the implantation, the values were: threshold 0.3 V, maximum R 28.8 mV. CONCLUSION Persistent left superior vena cava in some cases makes standard 58 cm endocardial lead placement impossible due to its joining to the right atrium over the dilated coronary sinus. Coronary sinus lead placement in the posterior or lateral coronary sinus branch represents an acceptable alternative approach for pacemaker lead placement in these patients.