Discussion
Polysplenia is a syndrome that is characterized by various anatomical findings, and it can be quite complex. In cases where there is isomerism of the left atrial appendages, individuals may experience one of three types of heart rhythm disturbances. These include atrioventricular block (4,5), dual atrioventricular nodal pathways and sinus node dysfunction (6). Patients with Polysplenia syndrome have been found to exhibit different mutations, such as LEFTYA3, Z1C3 etc. (6) Our patient, on the other hand, did not exhibit or undergo any study for such mutations.
The reported patient was an adult who had been diagnosed with polysplenia syndrome, had a structurally normal heart, and suffered from sinus node dysfunction. It is worth noting that the occurrence of isolated conduction disorder in patients with polysplenia syndrome and a structurally normal heart is quite rare and unusual (5).
When it comes to patients who have sinus node dysfunction, using AAI C/R and DDD C/R pacemakers for electrical stimulation yields a better outcome due to the reduced incidence of atrial fibrillation, thromboembolic events, and heart failure. This is supported by research findings mentioned in the source (3).
IVC interruption with azygous continuation is seen in left isomerism and affects the course of catheter or TPI (thrombolytic predictive instrument) lead while performing temporary pacemaker implantation from femoral vein access. Alternatively, one can choose for internal jugular vein access for TPI.
While doing TPI, one must be aware of the presence of left sided SVC and pacemaker lead course accordingly.