Left ventricular pacing in persistent left superior vena cava: a case series and potential application.

Persistent left superior vena cava (PLSVC) is found in 0.32 of the population. Pacemaker implant in PLSVC can be technically challenging. Most operators have hitherto manipulated ventricular leads through the coronary sinus (CS) into the right ventricle (RV). In this case series, we describe the use of standard passive tined ventricular leads implanted into the left ventricular (LV) epicardial veins in PLSVC. Three patients with PLSVC underwent pacemaker implantation for bradycardia. Contrast injection in the dilated CS identified LV coronary veins. Standard passive tined pacing leads were manoeuvred into these branches using hand-shaped stylets without need for additional equipment. Atrial leads were actively fixed to the anterolateral right atrial wall. There were no procedural complications. Chronic ventricular capture threshold at 6 months of follow-up was 1.0 mV@ 0.4 ms. Implanting standard leads into the LV veins in PLSVC is safe, effective, and simple without the need for special tools. This is easier than manipulating leads into the RV in PLSVC. Longer-term follow-up and dedicated clinical trials are needed to evaluate the efficacy and safety of this approach.