Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 1, February 2019, pages 18-23

Permanent Pacemaker Implantation in Patients With Isolated Persistent Left Superior Vena Cava From a Right-Sided Approach: Technical Considerations and Follow-Up Outcome

Figure 1. (a) TTE showing dilated coronary sinus. (b) Contrast phlebography from right upper limb showing isolated PLSVC. (c) Mond’s curve. (d) Alpha loop configuration of ventricular lead (passive fixation lead).

Figure 2. (a) Characteristic lead positions in a lateral view. (b) An antero-posterior view. (c) CT venography showing isolated PLSVC. (d) Multiple detector computed tomography (MDCT) showing isolated PLSVC.

**Table 1.** Echocardiographic Diagnosis of Isolated Persistent Left Superior Vena Cava and Its Possible Variation With Contrast Injection (Agitated Saline)
Agitated saline contrast	RSVC	Isolated PLSVC draining to RA	PLSVC with RSVC	LSVC draining into LA
LA: left atrium; PLSVC: persistent left superior vena cava; RSVC: right superior vena cava; RA: right atrium; CS: coronary sinus.
Contrast from the left arm	RA	CS to RA	CS to RA	LA
Contrast from the right arm	RA	CS to RA	RA	RA

Table 1. Echocardiographic Diagnosis of Isolated Persistent Left Superior Vena Cava and Its Possible Variation With Contrast Injection (Agitated Saline)

Agitated saline contrast

RSVC

Isolated PLSVC draining to RA

PLSVC with RSVC

LSVC draining into LA

LA: left atrium; PLSVC: persistent left superior vena cava; RSVC: right superior vena cava; RA: right atrium; CS: coronary sinus.

Contrast from the left arm

CS to RA

Contrast from the right arm

CS to RA

**Table 2.** Baseline Characteristics of Patients (n = 124)
Baseline characteristics	PM-PLSVC (n = 31, %)	PM-without PLSVC (n = 93, %)	P-value
AV block: atrioventricular block; BFB: bifascicular block; DM: diabetes mellitus; EF: ejection fraction; HTN: hypertension; NYHA: New York Heart Association; PLSVC: persistent left superior vena cava; PM: pacemaker implantation; SND: sinus node dysfunction; TFB: trifascicular block.
Age (years)	65.3 ± 11.6	64.4 ± 9.3	0.6
Sex (men/women)	19/12	57/36	0.5
HTN	6 (19%)	22 (24%)	0.4
DM	5 (16%)	19 (21%)	0.23
Ejection fraction (%)	62.5 ± 4	63.6 ± 5	0.34
Pacing indication
SND	13 (44%)	42 (45%)	0.18
AV block	13 (44%)	34 (37%)	0.16
Chronic BFB and TFB	05 (12%)	17 (18%)	0.2
Types of pacemaker
VVI/VVIR	09 (29)	36 (39)	0.4
DDD/DDDR	22 (71)	57 (61)	0.2
Types of pacing electrode
Tiened	05 (16)	14 (15)	0.3
Screwing	26 (84)	79 (85)	0.19

Table 2. Baseline Characteristics of Patients (n = 124)

Baseline characteristics

PM-PLSVC (n = 31, %)

PM-without PLSVC (n = 93, %)

P-value

AV block: atrioventricular block; BFB: bifascicular block; DM: diabetes mellitus; EF: ejection fraction; HTN: hypertension; NYHA: New York Heart Association; PLSVC: persistent left superior vena cava; PM: pacemaker implantation; SND: sinus node dysfunction; TFB: trifascicular block.

Age (years)

65.3 ± 11.6

64.4 ± 9.3

0.6

Sex (men/women)

19/12

57/36

0.5

HTN

6 (19%)

22 (24%)

0.4

5 (16%)

19 (21%)

0.23

Ejection fraction (%)

62.5 ± 4

63.6 ± 5

0.34

Pacing indication

SND

13 (44%)

42 (45%)

0.18

AV block

13 (44%)

34 (37%)

0.16

Chronic BFB and TFB

05 (12%)

17 (18%)

0.2

Types of pacemaker

VVI/VVIR

09 (29)

36 (39)

0.4

DDD/DDDR

22 (71)

57 (61)

0.2

Types of pacing electrode

Tiened

05 (16)

14 (15)

0.3

Screwing

26 (84)

79 (85)

0.19

**Table 3.** Clinical and Procedural Outcomes of Patients (n = 124)
Baseline characteristics	PM-PLSVC (n = 31, %)	PM-without PLSVC (n = 93, %)	P-value
PM: pacemaker implantation.
Procedural time (min)	25 ± 11	23 ± 12	0.24
Fluroscopic time (min)	3.1 ± 2.2	2.7 ± 2.1	0.54
Length of leads (cm)
Atrial	53	53	NS
Ventricular	58	58	NS
Pacing parameters
Atrial lead
Threshold (mV)	1.2 ± 0.1	1 ± 0.2	0.4
P-wave (mV)	4.1 ± 0.2	4.3 ± 0.1	0.5
Lead impedance (Ω)	580 ± 170	540 ± 140	0.2
Ventricular lead
Threshold (mV)	0.8 ± 0.3	0.9 ± 0.2	0.17
R-wave (mV)	14 ± 4	16 ± 1	0.32
Lead impedance (Ω)	800 ± 240	760 ± 20	0.22
Alpha loop (ventricular lead)	31 (100)	00	0.002
Lead dislodgement	01 (3.2)	03 (4.8)	0.32
Subclavian crush	00	00	0.00
Local site complication	02 (6.4)	07 (7.5)	0.5
Follow-up duration (years)	6.9 ± 1.3	7.2 ± 1.1	0.18

Table 3. Clinical and Procedural Outcomes of Patients (n = 124)

Baseline characteristics

PM-PLSVC (n = 31, %)

PM-without PLSVC (n = 93, %)

P-value

PM: pacemaker implantation.

Procedural time (min)

25 ± 11

23 ± 12

0.24

Fluroscopic time (min)

3.1 ± 2.2

2.7 ± 2.1

0.54

Length of leads (cm)

Atrial

Ventricular

Pacing parameters

Atrial lead

Threshold (mV)

1.2 ± 0.1

1 ± 0.2

0.4

P-wave (mV)

4.1 ± 0.2

4.3 ± 0.1

0.5

Lead impedance (Ω)

580 ± 170

540 ± 140

0.2

Ventricular lead

Threshold (mV)

0.8 ± 0.3

0.9 ± 0.2

0.17

R-wave (mV)

14 ± 4

16 ± 1

0.32

Lead impedance (Ω)

800 ± 240

760 ± 20

0.22

Alpha loop (ventricular lead)

31 (100)

0.002

Lead dislodgement

01 (3.2)

03 (4.8)

0.32

Subclavian crush

0.00

Local site complication

02 (6.4)

07 (7.5)

0.5

Follow-up duration (years)

6.9 ± 1.3

7.2 ± 1.1

0.18