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Erath J.W.,Goethe University Frankfurt | Sirat A.S.,Dep. of Cardio Thoracic Surgery | Vamos M.,Goethe University Frankfurt | Hohnloser S.H.,Goethe University Frankfurt
Herzschrittmachertherapie und Elektrophysiologie | Year: 2016

Persistent left superior vena cava is known to be a challenging anatomic abnormality for transvenous cardiac device implantation. In the a case of a young man presenting with dilative cardiomyopathy with severely impaired left ventricular ejection fraction (LVEF) and second-degree atrioventricular block (AV block), cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) implantation was indicated. A transvenous approach was attempted, but placement of the right ventricular lead was not successful due to anatomic abnormalities. Therefore, epicardial CRT leads were implanted via a left mini-thoracotomy. For primary prevention of sudden death, the patient was also fitted with an additional subcutaneous implantable cardioverter defibrillator (S-ICD). Any cross-talk between the devices was ruled out both intraoperatively and by ergometry prior to discharge. The combination of epicardial CRT-P with S‑ICD implantation might be a safe and effective alternative in patients with cardiac anatomic abnormalities. © 2016 Springer-Verlag Berlin Heidelberg


PubMed | Dep. of Cardio Thoracic Surgery and Goethe University Frankfurt
Type: Journal Article | Journal: Herzschrittmachertherapie & Elektrophysiologie | Year: 2016

Persistent left superior vena cava is known to be achallenging anatomic abnormality for transvenous cardiac device implantation. In the acase of ayoung man presenting with dilative cardiomyopathy with severely impaired left ventricular ejection fraction (LVEF) and second-degree atrioventricular block (AVblock), cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) implantation was indicated. Atransvenous approach was attempted, but placement of the right ventricular lead was not successful due to anatomic abnormalities. Therefore, epicardial CRT leads were implanted via aleft mini-thoracotomy. For primary prevention of sudden death, the patient was also fitted with an additional subcutaneous implantable cardioverter defibrillator (S-ICD). Any cross-talk between the devices was ruled out both intraoperatively and by ergometry prior to discharge. The combination of epicardial CRT-P with SICD implantation might be asafe and effective alternative in patients with cardiac anatomic abnormalities.

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