Implantation of Dual-Chamber Cardioverter-Defibrillator through Left Iliac Vein in a Patient with Occluded Superior Vena Cava.

The occlusion of the superior vena cava is a known complication of repeated procedures related to pacemaker and implantable cardioverter-defibrillator devices. The insertion of implantable cardioverter-defibrillators in patients with this complication entails the practical problem of how to gain access to the heart. Surgical placement of epicardial leads and patches, using thoracotomy,is an established alternative but has its inherent problems, including high surgical risk. Also, the necessary hardware is not easily available. The existing literature has few reports of the insertion of implantable cardioverter-defibrillators through alternative transvenous routes. We report a case of implantation of a dual-chamber implantable cardioverter-defibrillator through the left iliac vein in a patient with arrhythmogenic right ventricular dysplasia, recurrent ventricular tachycardia and an occluded superior vena cava.