Erath Julia W, Sirat Abdul Sami, Vamos Mate, Hohnloser Stefan H
Dep. of Cardiology, Div. of Clinical Electrophysiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Dep. of Cardio-Thoracic Surgery, Helios Klinikum Siegburg, Siegburg, Germany.
Herzschrittmacherther Elektrophysiol. 2016 Dec;27(4):396-398. doi: 10.1007/s00399-016-0451-5. Epub 2016 Sep 19.
Persistent left superior vena cava is known to be a challenging anatomic abnormality for transvenous cardiac device implantation. In the a case of a young man presenting with dilative cardiomyopathy with severely impaired left ventricular ejection fraction (LVEF) and second-degree atrioventricular block (AV block), cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) implantation was indicated. A transvenous approach was attempted, but placement of the right ventricular lead was not successful due to anatomic abnormalities. Therefore, epicardial CRT leads were implanted via a left mini-thoracotomy. For primary prevention of sudden death, the patient was also fitted with an additional subcutaneous implantable cardioverter defibrillator (S-ICD). Any cross-talk between the devices was ruled out both intraoperatively and by ergometry prior to discharge. The combination of epicardial CRT-P with S‑ICD implantation might be a safe and effective alternative in patients with cardiac anatomic abnormalities.
永存左上腔静脉被认为是经静脉心脏装置植入术中具有挑战性的解剖学异常。在一名患有扩张型心肌病且左心室射血分数（LVEF）严重受损和二度房室传导阻滞（AV阻滞）的年轻男性病例中，指示进行植入式心脏复律除颤器（CRT-D）的心脏再同步治疗（CRT）。尝试了经静脉途径，但由于解剖学异常，右心室导线的放置未成功。因此，通过左前胸小切口植入了心外膜CRT导线。为了一级预防猝死，还为该患者植入了额外的皮下植入式心律转复除颤器（S-ICD）。在术中以及出院前通过测力计排除了装置之间的任何串扰。在心外膜CRT-P与S-ICD植入相结合可能是心脏解剖学异常患者的一种安全有效的替代方案。
