Background: There are limited data on cardiac implantable electronic device implantation (CIED) in patients with persistent left superior vena cava (PLSVC).
Objective: To describe the feasibility and outcomes of implanting CIEDs with a focus on cardiac resynchronization therapy (CRT) in patients with PLSVC.
Methods: We identified all patients with a PLSVC that underwent CIED implantation from December 2008 until February 2019 at a single institution by querying the electronic medical record using diagnosis and billing codes (n=32). We then identified controls in a 3:1 fashion (n=96) by matching on device type (CRT vs. non-CRT), demographics, and comorbidities. Procedure success, complications, fluoroscopy and procedural time were recorded. Outcomes were compared using a two-way ANOVA test and conditional regression modeling for continuous and categorical variables, respectively.
Results: A total of 32 patients with PLSVC underwent 36 procedures. Three patients underwent dual chamber system followed by a subsequent upgrade to CRT. Eleven patients underwent de novo CRT. Two were implanted via the right subclavian while the rest were implanted via the PLSVC. LV lead implant was successful in 10 patients (90.9%). The failed implant was reattempted successfully from the right and tunneled to the left. Twenty-five patients underwent non-CRT system implant with 100% success rate. Six patients were implanted via the right subclavian while 19 were implanted via the PLSVC. Procedural success in the PLSVC and control group was similar (97% vs. 94.3%,p=0.629). Right ventricular lead dislodgment occurred in 5.5% of patients in the PLSVC group (treated with lead revision) vs. 0.0% in the control group (p=0.061). There was a trend towards higher Infection rate in the PLSVC group (5.5% vs. 0%, P=0.073). Procedure and fluoroscopy time were significantly higher in the PLSVC as compared to the control group (98.4 vs. 69.4 min, p= 0.002 and 17.8 min vs. 9.36 min, p=0.021).
Conclusion: CIED implant in patients with PLSVC is feasible but technically more challenging and appears to be associated with higher risk of RV lead dislodgment. Choosing the right subclavian approach in this population might reduce the risk of lead dislodgment and decrease procedure and fluoroscopy time.