Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2015; 7(1): 43-46
Published online Jan 26, 2015. doi: 10.4330/wjc.v7.i1.43
Permanent transvenous pacemaker implantation in a patient with Cor triatriatum dextrum
Kun Xiang, George V Moukarbel, Blair Grubb
Kun Xiang, George V Moukarbel, Blair Grubb, Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH 43614, United States
Author contributions: Xiang K, Moukarbel GV and Grubb B designed and wrote the report; Xiang K and Moukarbel GV performed the transesophageal echocardiogram; Xiang K and Grubb B performed the dual-chamber pacemaker placement.
Ethics approval: This is a clinical case report. All patients related identification information have been avoided according to the policy of University of Toledo Medical Center and the Health Insurance Portability and Accountability Act (HIPPA) by the United State of America.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: All authors have no conflict-of-interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Blair Grubb, MD, Division of Cardiovascular Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614, United States. blair.grubb@utoledo.edu
Telephone: +1-419-3833963 Fax: +1-419-3836167
Received: August 17, 2014
Peer-review started: August 20, 2014
First decision: November 19, 2014
Revised: December 3, 2014
Accepted: December 18, 2014
Article in press: January 4, 2015
Published online: January 26, 2015
Processing time: 157 Days and 15.5 Hours
Abstract

Cor triatriatum dextrum is an extremely rare congenital heart abnormality in which the right atrium is separated into two chambers by a persistent fibrous membrane. A transvenous approach to place a dual-chamber pacemaker in such patients is technically challenging. We report the first case of a transvenous permanent pacemaker placement in a patient with cor triatriatum dextrum. An 87-year-old woman was diagnosed with paroxysmal atrial fibrillation. She was accidentally found to have cor triatriatum dextrum during the transesophageal echocardiography (TEE) prior to cardioversion. Later during her hospital stay, it was indicated to place a permanant pacemaker due to high grade atrioventricular block. After thorough reviewing TEE imagings, a transvenous catheter-based approach was decided feasible. Patient successfully received a dual chamber pacemaker through left subclavian venous approach. Furthermore in our case, using specially designed pacemaker leads and cautious intra-procedural maneuvering under fluoroscopic guidance ensured procedural success. In summary, a thorough pre-operative evaluation with transesophageal echocardiography is critical for the planning and eventual success of the transvenous placement of right-sided leads.

Keywords: Congenital heart defect; Complete heart block; Inter-atrial membrane; Dual-chamber pacemaker

Core tip: Cor triatriatum dextrum is an extremely rare congenital heart abnormality in which the right atrium is separated by a persistent fibrous membrane. This membrane poses a technical challenge for dual-chamber pacemaker placement through the transvenous approach. Here we report the first transvenous pacemaker placement in a patient with cor triatriatum dextrum. A thorough pre-operative evaluation by transesophageal echocardiogram was critical for the planning of transvenous catheter-based right-sided leads placement. Using specially designed pacemaker leads and cautious intra-procedural maneuvering under fluoroscopic guidance ensured procedural success.