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Clin. Cardiol. 24, 526 (2001)
This section edited by Edward A. Geiser, M.D.
Stephen J. Duffy, M.B., B.S., FRACP, MRCP, and Jeffrey F. Alison, M.B., B.S., FRACP
The Centre for Heart and Chest Research, Monash Medical Centre and Monash University, Melbourne, Australia
| Fig. 1 Posteroanterior chest x-ray postimplantation of a dual chamber permanent pacemaker showing the course of the leads through a persistent left-sided superior vena cava and the coronary sinus. |
| Fig. 2 Lateral chest x-ray of the same patient. Additional loops of the leads were used to ensure that there was no tension on the leads with respiratory excursions or voluntary movements. |
A 71-year-old man with a history of hypertension and Parkinson's disease was referred for permanent pacemaker implantation after a two-week history of presyncopal episodes associated with intermittent complete heart block detected on Holter monitoring. Approach by the left cephalic and subclavian veins for the ventricular and atrial leads, respectively, resulted in unexpected entrance into the right atrium via the coronary sinus. Passive right ventricular lead fixation and active right atrial appendage fixation yielded good pacing thresholds, which remain similar three years after implantation. The posteroanterior (Fig. 1) and lateral (Fig. 2) chest x-rays demonstrate the course of the leads and satisfactory lead positions.
Persistent left superior vena cava is a relatively common congenital abnormality, occurring in 0.5% of normal patients, and in 3 to 10% of children with other congenital cardiac anomalies.1 Current pacemaker technology allows the safe and effective completion of implantation despite the anomaly.
Dr. Duffy was supported by medical postgraduate research scholarship (no. 958123) from the National Health and Medical Research Council of Australia
Reference