Right-Sided Permanent Pacemaker Implantation in Patients with Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava: 3-Case Series, Technique and Discussion

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for

researchers?

A: Good

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

A: Very Good

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

A: Very Good

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

A: Good

Tools and Methods

Q: Are methods the author uses adequate and well used?

A: Good

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

A: Good

Comments: The Discussion states that persistent left superior vena cava (PLSVC) is rare in the general population and the prevalence of PLSVC with the absence of right superior vena cava (RSVC) is difficult to assess. PLSVC is of importance to implanting physicians due to the difficulty in implantation of the ventricular lead. The Discussion highlights that for the three cases reported there was no need for a special form of a stylet for the implantation of the ventricular lead. Relevant literature has been cited to support the discussion. The Discussion establishes that PLSVC with absent RSVC is a rare anatomical variant that can cause difficulties during cardiac device implantation. The study concludes that performing right-sided implants using a conventionally shaped stylet for right ventricular septal placement and a wide-curve C-shape stylet for lateral wall right atrium placement is a feasible technique with good outcomes.

Literature

Q: Does the author utilize relevant literature?

A: Good

Author's knowledge

Q: What is the level of the author’s knowledge? Does the author utilize all recent contributions relevant to the topic?

A: Good

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

A: Good

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: Good

Writing style

Q: Is it clear and understandable?

A: Good

Comments: Except the following error was detected:

1.     The phrase “angiotensin conversion enzyme” should be replaced with “angiotensin converting enzyme”.

Further comments on the paper

Comments: The case report presents the case of permanent cardiac pacemakers (PPM) implantations in a tertiary center from the right side in 3 patients, a 76-year-old woman, a 57-year-old man and a 69-year-old man, with persistent left superior vena cava (PLSVC) and absent right superior vena cava (RSVC). PLSVC is usually asymptomatic and it is known to complicate transvenous cardiac procedures. The true prevalence of PLSVC with the absence of RSVC is largely unknown because most published cases of cardiac device implantations in patients with PLSVC have been performed from the left side and can be diagnosed in practice only when implanting from the right side. A wide-curve C-stylet was used to advance the lead from the PLSVC into the right atrium (RA) and screw it into the high lateral RA wall. For the 76-year-old woman pacemaker checks at 6- and 12-months follow-up showed good electrical parameters and for the 57-year-old man PPM check at 12-months follow-up showed good electrical parameters. However, the long-term follow-up data for the 69-year-old man was not available. The study concludes that the use of a standard curve for ventricular lead septal placement and a wide C-curve for right atrial lead placement in these patients was a feasible technique with good outcomes.

Q: Would you recommend this manuscript for further publication?

A: Yes - Suitable to be published

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