Abstract
A 60-year-old man underwent attempted cardiac resynchronization with defibrillator therapy utilizing a left-sided approach. A persistent left-sided superior vena cava (SVC) was identified and a dual-coil defibrillator lead (Sprint Fidelis; Medtronic) and atrial lead were deployed via this route (Figure 1A). No left ventricular (LV) branches of the coronary sinus (CS) were identified and so an LV pacing lead was implanted surgically onto the anterior aspect of the LV via a mini-thoracomtomy. The patient presented 5 years later with inappropriate shocks secondary to suspected fracture of the defibrillator lead. Laser lead extraction of the defibrillator lead via the left SVC was performed successfully. A contrast-enhanced cardiac computed tomography scan was performed as a prelude to extraction and a three-dimensional (3D) segmented anatomy of the cardiac chambers was derived using fully automated prototype segmentation software (Philips Healthcare). Further manual segmentation was performed to identify the main CS and branches. The 3D model was overlaid onto real-time fluoroscopy using prototype software (Philips Healthcare). This enabled successful implantation of a transvenous LV pacing lead into a more conventional posterolateral position (Figure 1C). To our knowledge, this is the first report of successful laser lead extraction of an implantable cardioverter defibrillator lead via a persistent left SVC. Our case also demonstrates the value of advanced imaging techniques in difficult cases of transvenous LV lead implantation.
| Original language | English |
|---|---|
| Pages (from-to) | 1173-1173 |
| Number of pages | 1 |
| Journal | EUROPACE |
| Volume | 15 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 2013 |