RESUMEN
Persistent left superior vena is a relatively rare congenital variant. It is, however, the most common variation of the thoracic venous system. Prevalence is estimated in about 0.6 to 1.0% during pacemaker placement. This finding, often incidental, can difficult the lead progression through the left jugular or subclavian routes. This report describes a case of successful pacemaker implantation through a persistent left superior vena. Technical difficulties were overcome using the pacemaker electrode as unipolar lead. Endocavitary ECG recording helped us to guide the lead through the tortuous anatomy. A stable lead position was finally achieved by means of the active fixation system of the pacemaker electrode.
Asunto(s)
Marcapaso Artificial , Vena Cava Superior/anomalías , Anciano , Anciano de 80 o más Años , Electrocardiografía , Femenino , Fluoroscopía , Estudios de Seguimiento , Humanos , Radiografía Torácica , Factores de TiempoRESUMEN
La presencia de una vena cava superior izquierda persistente es una variante congénita poco frecuente. Es, sin embargo, la anomalía más común del sistema venoso torácico. Su prevalencia ha sido estimada en 0.6 a 1.0% durante la implantación de marcapasos. Este hallazgo, frecuentemente incidental, puede dificultar la progresión del electrodo del marcapaso a través de los abordajes yugular o subclavio izquierdos. En este reporte presentamos la exitosa implantación de un marcapaso a través de una vena cava superior izquierda persistente. Las dificultades técnicas durante el procedimiento fueron resueltas usando el cable del marcapaso a manera de electrodo unipolar. El registro del electrograma endocavitario nos ayudó a guiar el electrodo a través de la anatomía difícil. Una posición estable final se logró mediante la utilización de un sistema de fijación activa.
Persistent left superior vena is a relatively rare congenital variant. It is, however, the most common variation of the thoracic venous system. Prevalence is estimated in about 0.6 to 1.0% during pacemaker placement. This finding, often incidental, can difficult the lead progression through the left jugular or subclavian routes. This report describes a case of successful pacemaker implantation through a persistent left superior vena. Technical difficulties were overcome using the pacemaker electrode as unipolar lead. Endocavitary ECG recording helped us to guide the lead through the tortuous anatomy. A stable lead position was finally achieved by means of the active fixation system of the pacemaker electrode.