Korean J Med.  2016 Jun;90(6):514-517. 10.3904/kjm.2016.90.6.514.

Permanent Pacemaker Implantation in a Patient with Mirror-Image Dextrocardia and Situs Inversus Totalis

• Choi WJ
• Park JS
• Kim SY
• Kim EY

• KMID: 2218773
• DOI: http://doi.org/10.3904/kjm.2016.90.6.514

Abstract

A 68-year-old female patient with situs inversus totalis was referred for permanent pacemaker implantation to treat a symptomatic sinus pause. The initial electrocardiographic findings suggested the presence of mirror-image dextrocardia. No congenital anomalies were evident on pre-procedural examination. To explore the relevant anatomy, electrode catheters were placed at the right ventricular apex, the His bundle area, and the high right atrium under guidance via intracardiac electrography and fluoroscopy. The left and right anterior oblique views of the dextrocardia were mirror images of the right and left (respectively) anterior oblique views of a normal heart. Pacing leads were successfully positioned at the upper interventricular septum and the right atrial appendage. Dextrocardia is a rare congenital anomaly, and the accompanying anatomical distortions can render device implantation challenging. We suggest that pre-procedural fluoroscopic evaluation using electrode catheters can provide critical data on anatomical landmarks allowing effective positioning of pacing leads.

Keyword

Pacemaker, Artificial; Dextrocardia; Situs inversus

MeSH Terms

Aged
Atrial Appendage
Bundle of His
Catheters
Dextrocardia*
Electrocardiography
Electrodes
Female
Fluoroscopy
Heart
Heart Atria
Humans
Pacemaker, Artificial
Situs Inversus*