An unusual ‘bow tie’ image in pacemaker implantation

Abstract

Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.

Keywords

• Cardiac pacemaker
• Persistent left superior vena cava
• Absent right superior vena cava
• Pacemaker electrode