Chest
Volume 120, Issue 1, July 2001, Pages 139-144
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Clinical Investigations
Cardiology
Left Superior Vena Cava Persistence in Patients Undergoing Pacemaker or Cardioverter-Defibrillator Implantation: A 10-Year Experience

https://doi.org/10.1378/chest.120.1.139Get rights and content

Objective

The persistence of a left superior vena cava(LSVC) has been observed in 0.3% of the general population asestablished by autopsy. In the adult population, it is an importantanatomic finding if a left superior approach to the heart isconsidered. The aim of the study was to evaluate the prevalence of aLSVC in patients undergoing pacemaker (PM) andcardioverter-defibrillator (CD) implantation.

Design

We observed the prevalence of LSVC during a 10-year period; eachpatient undergoing PM or transvenous CD implantation received a leftcephalic/left subclavian venous approach to the heart. With thistechnique, LSVC persistence is easily diagnosed during leadplacement.

Results

A total of 1,139 patientsconsecutively underwent PM implantation during 10 years: 4 patients hadpersistent LSCV (0.34%). Among 115 patients undergoing CDimplantation, 2 patients with LSVC (1.7%) were observed. Overall LSVCpersistence was found in 6 of 1,254 patients (0.47%). Two patients, one of whom had no right superior vena cava (RSVC), received aleft-sided PM, whereas two other patients received right-sided devices. Both CD patients received a left-sided active-can device: the firstpatient with a right-sided lead tunneled to the left pectoral pocket, as a result of poor catheter handling through the LSVC and coronarysinus, and the second patient with a screw-in lead from LSVC. Long-termfollow-up of these patients (average ± SD, 41 ± 26 months)revealed absence of lead dislodgment and appropriate device functionregardless of lead implantation site.

Conclusions

Persistence of LSVC in adults undergoing PM/CD implantation is similarto that of the general population (0.47% in our study). The left-sidedimplant can be achieved by stylet shaping and by use of active fixationleads in most patients, with a reliable outcome at short term inaddition to appropriate device performance at follow-up. Assessment ofthe RSVC is advisable when planning a right-sided implantation, since aminority of patients lacks this vessel.

Section snippets

Materials and Methods

The study was prospectively conducted from October 1989 to September 1999 on all patients undergoing PM implantation; from January 1992 to September 1999, patients undergoing transvenous CD implantation were also taken into consideration. Patients with congenital thoracic-abdominal abnormalities were not considered due to the likelihood of associated LSVC persistence5,6,7,8; this would have increased the prevalence in the patients with bradyarrhythmias and tachyarrhythmias. Patients requiring

Results

During 10 years, 1,147 consecutive patients without congenital abnormalities underwent PM implantation for commonly accepted indications; 8 patients were occasionally discovered to have asymptomatic left subclavian thrombosis (angiographically documented during implantation) and were hence excluded from analysis due to the impossibility of ruling out LSVC persistence. Of the other 1,139 patients, 627 patients were male (55%) and 512 were female (45%); 4 of 1,139 patients had patency of LSVC

Discussion

Persistence of LSVC in adult life is normal in rabbits and some other mammals, but it is a rare abnormality in man. Besides being associated with congenital diseases,5,6,7,8 its most relevant clinical implication is the association with disturbances of cardiac impulse formation and conduction.20 The ontogenetic development of the sinus node, the AV node, and the His bundle may be heavily influenced by the lack of regression of the left cardinal vein,21,22,23 since these structures are located

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