Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.
Division of Cardiology, GZO Zurich Regional Health Center Wetzikon, Wetzikon, Switzerland.
J Interv Card Electrophysiol. 2024 Oct;67(7):1505-1516. doi: 10.1007/s10840-024-01761-7. Epub 2024 Feb 12.
Persistent left superior vena cava (PLSVC) is a rare venous anomaly, affecting 0.3-0.5% of the general population. Cardiac resynchronization therapy (CRT) implantation in patients with PLSVC is challenging due to a complex anatomy. Moreover, data on CRT implantation in this patient population is scarce. Our aim was to report a series of patients with PLSVC and CRT implantation focusing on challenges and pitfalls.
Electronic medical databases on patients with CRT implantation at the University Heart Centers in Zurich, Switzerland, and Lübeck, Germany, were screened for individuals with a PLSVC. Clinical and demographic characteristics as well as procedural data were reported in all patients.
This study presents six cases with a median age of 66 years. CRT implantation was successful in five patients, leading to a reduced QRS duration and improved left ventricular ejection fraction. Atrial fibrillation, ischemic cardiomyopathy, valvular heart disease, and dilated cardiomyopathy were observed in this group as underlying conditions. Specialized tools, such as active fixation left ventricular leads, were utilized. One patient experienced major complications.
This case series shows that although challenging, conventional endovascular CRT implantation is feasible in PLSVC patients. Specialized tools for visualization and fixation may help. Our experiences highlight the importance of preprocedural evaluation of the anatomy and precise intervention planning.
永存左上腔静脉（PLSVC）是一种罕见的静脉异常，影响 0.3-0.5%的普通人群。由于解剖结构复杂，在患有 PLSVC 的患者中植入心脏再同步治疗（CRT）具有挑战性。此外，关于该患者群体中 CRT 植入的数据也很少。我们的目的是报告一系列患有 PLSVC 和 CRT 植入的患者，重点关注挑战和陷阱。
在瑞士苏黎世大学心脏中心和德国吕贝克的电子病历数据库中筛选出接受 CRT 植入的患者中存在 PLSVC 的个体。所有患者均报告了临床和人口统计学特征以及手术数据。
本研究介绍了 6 例患者，中位年龄为 66 岁。5 例患者 CRT 植入成功，导致 QRS 持续时间缩短，左心室射血分数提高。该组患者存在房颤、缺血性心肌病、瓣膜性心脏病和扩张型心肌病等基础疾病。使用了专用工具，如主动固定左心室导联。1 例患者发生严重并发症。
本病例系列表明，尽管具有挑战性，但常规血管内 CRT 植入在 PLSVC 患者中是可行的。用于可视化和固定的专用工具可能会有所帮助。我们的经验强调了术前评估解剖结构和精确干预计划的重要性。
