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Alf Inge Larsen, Dennis W. Nilsen, Persistent left superior vena cava. Use of an innominate vein between left and right superior caval veins for the placement of a right ventricular lead during ICD/CRT implantation, European Heart Journal, Volume 26, Issue 20, October 2005, Page 2178, https://doi.org/10.1093/eurheartj/ehi516
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This patient with congestive heart failure, atrial fibrillation, mild renal impairment, chronic lung disease, and diabetes mellitus underwent CABG 2 weeks prior to the implantation of a combined implantable cardioverter defibrillator/cardiac resynchronization therapy (ICD/CRT) device with access via the left subclavian vein. During the procedure, we found that the patient had a persistent left superior vena cava. The prevalence of this condition in patients without congenital heart disease is estimated to be 0.3–3.0%. Some of these patients also have an innominate vein connecting the two superior venous drainage systems. In our patient, we directed the ‘left ventricular lead’ to a left cardiac vein employing the persistent left superior vena cava draining into the coronary sinus. However, the ICD lead could not be easily placed in the right ventricle using this pathway. Fortunately, our patient had an innominate vein connecting the two superior drainage systems, allowing the advancement of the ICD lead from the left to the right caval system and further on into the right ventricle. A right atrial lead was not needed due to chronic atrial fibrillation.