Allied Professionals (Non-physician submissions only) -> Teaching Case Reports D-AB18 - Quirks and Quarks from the EP Lab (ID 38) Abstract

D-AB18-03 - His-Crt Implantation In Scimitar Syndrome Using Cartoseg™ And Cartounivu™ (ID 1448)

Abstract

Background: Scimitar syndrome is characterized by anomalous drainage of the right pulmonary veins into the inferior vena cava (IVC) and is associated with right lung hypoplasia, dextrocardia and atrial septal defect (ASD).
Objective: We report the case of a cardiac resynchronization (CRT) implantation with a lead positioned at the His Bundle in a patient with Scimitar Syndrome.
Results: A 70yo female with Scimitar Syndrome, NYHA III symptoms and an ejection fraction of 25% presented for implantation of a CRT-D. Utilising CARTOSEG™ and CARTOUNIVU™, a CT reconstruction was performed to better understand the patient’s anatomy (figures 1 and 2). With a quadrapolar catheter placed in right ventricular (RV) apex for back-up pacing, a high voltage lead was advanced to the RV septum. A steerable decapolar catheter was then advanced in the coronary sinus (CS) and 3 tributaries targeted for lead advancement. Unfortunately, all the tributaries had extremely angulated and tortuous take-off excluding them from successful lead implantation. A C315 catheter was then advanced over a long guidewire and the His Bundle region mapped. A Medtronic® 69cm 3830 pacing lead was successfully screwed into the septum at the His region (figures 3 and 4). The resulted in the successful correction of the patient’s left bundle branch block (QRS from 196 ms to 146 ms; figures 5 and 6).
Conclusion: This case is the first described His-CRT implant in a patient with Scimitar Syndrome, successfully correcting left bundle branch block and acutely improving their heart failure symptoms.

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