A 61-year-old woman with a history of symptomatic sinus node disease and paroxysmal atrial fibrillation was referred for definitive implantation of bilayer.
Left subclavian access guide implant was used, but as the guide wire advanced, it was observed that the guide wire followed an abnormal path, descending and descending towards the left attempt.
The contrast injection confirmed the existence of a left superior vena cava.
It was decided to attempt the implant through the right subclavian vein, which failed due to the absence of right superior vena cava.
The procedure was interposed and the possibility of implanting epicardial electrodes or reinserting the implant through the persistent left superior vena cava was discussed with the patient.
We opted for the second alternative, and in the electrophysiology laboratory performed double puncture of the left axillary vein and through the left superior sinus Jude®, two straight vena cava electrodes were advanced by active coronary fixation (S1488).
The ventricular electrode advanced to the right atrium and a loop was made towards the tricuspid annulus, advancing the electrode to the basal region of the right ventricle where it was positioned, obtaining a threshold of 6.0 oh30 R Volm.
The auricular electrode was positioned on the lateral side of the right atrium, where a sensed P wave of 5.4 mV was obtained, an auricular stimulation threshold of 0.6 Volt., with impedance of 500 Ohm.
There were no complications associated with the procedure and the patient was discharged after 24 h.
Subsequent controls have shown that functioning parameters have remained stable at 2 years of follow-up.
