Li N, Wang HX, Sun YH, Shu Y. Successful leadless pacemaker implantation in a patient with dextroversion of the heart: A case report. World J Clin Cases 2023; 11(33): 8089-8093 [PMID: 38075583 DOI: 10.12998/wjcc.v11.i33.8089]
Corresponding Author of This Article
Yan Shu, Doctor, PhD, Chief Pharmacist, Department of Cardiology, Shanxi Cardiovascular Hospital, No. 18 Yifen Street, Taiyuan 030000, Shanxi Province, China. shuyan20230919@163.com
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Cardiac & Cardiovascular Systems
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Case Report
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Nov 26, 2023 (publication date) through Feb 14, 2026
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World Journal of Clinical Cases
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2307-8960
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Li N, Wang HX, Sun YH, Shu Y. Successful leadless pacemaker implantation in a patient with dextroversion of the heart: A case report. World J Clin Cases 2023; 11(33): 8089-8093 [PMID: 38075583 DOI: 10.12998/wjcc.v11.i33.8089]
World J Clin Cases. Nov 26, 2023; 11(33): 8089-8093 Published online Nov 26, 2023. doi: 10.12998/wjcc.v11.i33.8089
Successful leadless pacemaker implantation in a patient with dextroversion of the heart: A case report
Na Li, Hai-Xiong Wang, Yue-Hui Sun, Yan Shu
Na Li, Hai-Xiong Wang, Yue-Hui Sun, Yan Shu, Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan 030000, Shanxi Province, China
Co-first authors: Na Li and Yue-Hui Sun.
Co-corresponding authors: Yan Shu and Hai-Xiong Wang.
Author contributions: Shu Y and Wang HX made an equal contribution to this work, and were responsible for the design of the research study; Li N and Sun YH analyzed the data and wrote the manuscript; Every author has reviewed and given their approval to the final draft of the manuscript.
Supported byShanxi Provincial Health Commission “Four batch” Science and Technology Innovation Project of Medical Development, No. 2021XM45; Natural Science Foundation of Shanxi Province, No. 20210302123346; Scientific Research Incentive Fund of Shanxi Cardiovascular Hospital, No. XYS20220205; and Traditional Chinese Medicine research project of Shanxi Province, No. 2023ZYYA028.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Yan Shu, Doctor, PhD, Chief Pharmacist, Department of Cardiology, Shanxi Cardiovascular Hospital, No. 18 Yifen Street, Taiyuan 030000, Shanxi Province, China. shuyan20230919@163.com
Received: September 19, 2023 Peer-review started: September 19, 2023 First decision: October 17, 2023 Revised: October 22, 2023 Accepted: November 14, 2023 Article in press: November 14, 2023 Published online: November 26, 2023 Processing time: 66 Days and 1.3 Hours
Abstract
BACKGROUND
Dextroversion is defined as the presence of dextrocardia with situs solitus, dextro-loop ventricles, and normally related great arteries. Dextrocardia can pose technical challenges when interventional treatments are required. However, the challenges posed by dextroversion can be amplified due to the disruption of typical anatomical relationships, the unpredictable positioning and boundaries of cardiac structures resulting from the shift, and the pathological processes influencing rotation.
CASE SUMMARY
A 73-year-old woman with cardiac dextroversion suffered from a recurrence of atrial fibrillation after her radiofrequency catheter ablation and Despite the cessation of antiarrhythmic medications, there were episodes of sinus pauses and symptomatic bradycardia, with heart rates dropping as low as 28 beats per minute.
CONCLUSION
Dextroversion makes the implantation of leadless pacemakers more challenging, and appropriate adjustments in fluoroscope angles may be crucial for intracardiac operations. Additionally, when advancing delivery systems, attention should be paid to rotational direction during valve-crossing procedures; changes in the perspective of posture angle between normal cardiac position and dextroversion can serve as references.
Core Tip: Dextroversion can be even more challenging given the distortion of normal anatomical relationships and the uncertainty of the accurate location and borders of the cardiac structures caused by the shift and rotation effected by the pathologic process. We present a complicated but successful case of implantation of a leadless pacemaker in a patient with cardiac dextroversion.
