Cinosh Mathew

Persistent left superior vena cava: A challenge for permanent pacemaker implantation

Persistent left superior vena cava is the most common variation in the anomalous venous return to the heart. It is usually asymptomatic and discovered incidentally during imaging and the aberrant position of a pacemaker lead, central venous catheters, or retrograde cardioplegia for cardiac surgery. We present two different approaches of pacemaker implantation in this congenital anomaly.

Syncope as a presenting feature of complete extrusion of a unipolar permanent pacemaker

Complete extrusion of a permanent pacemaker is an extremely rare complication. We report a unique case of a patient presenting with syncopal episodes after complete extrusion of his implanted pacemaker. An 82-year-old gentleman with a history of pacemaker implantation, 6 years back, presented with syncopal episodes and was found to have complete extrusion of his pacemaker out of its pocket. An electrocardiography revealed complete heart block which would revert to paced rhythm when the pulse generator would be pushed back into the pacemaker pocket. Neglecting the pre-extrusion stage, he presented with syncopal episodes after complete extrusion and loss of contact of the unipolar pacemaker with the pacemaker pocket resulting in complete loss of pacing.