In this month’s issue of EP Lab Digest®, we feature several interesting case study articles. Archana Kodali, MD and Koroush Khalighi, MD, FAOP, FACC, FCCP from Easton Hospital in Pennsylvania describe the association of superior vena cava syndrome (SVCS) with an intracardiac device and antiphospholipid antibodies. A partial or complete obstruction of the superior vena cava results in a variety of symptoms called SVCS. The authors present a case study, and discuss both the presentation and management of SVCS. They write that even though the majority of SVCS cases are from an underlying malignancy, with the increased usage of intracardiac devices, there should be a high suspicion for clinical diagnosis in these settings.
Kenneth Yamamura, MD, FACC and Bonnie McDonald RN, CEPS, RCIS from the Pepin Heart Institute at Florida Hospital Tampa in Florida present a case of a 67-year-old woman with undiagnosed persistent left superior vena cava (PLSVC). This is the most common congenital venous anomaly in the chest, occurring in between 0.3-0.5% of all patients. A PLSVC can be accurately diagnosed by echocardiography, CT or MR imaging, or intraoperatively during vascular access by noting an unusual course of a guide wire, catheter, or pacing lead.
Finally, Alyssa M. Feldman, MS and colleagues from Winthrop University Hospital in New York describe a case of atrial fibrillation recurrence in which repeated cardioversion, contact pressure, patch placement, and preloading with sotalol helped result in a successful outcome. The patient was a 61-year-old man who was clinically obese, with an elevated body mass index of 40.6 kg/m2. Their case highlights the principles of changing patch placement and applying pressure over the patch to lower transthoracic impedance. In addition, increasing cardioversion energy delivered by the defibrillator proved useful in this case.