Dextrocardia and slow atrial fibrillation treated with permanent pacemaker implantation. Case report

Abstract

Introduction: Dextrocardia is a rare condition (1:10,000 live births), and its association with conduction system disorders is even rarer. The presence of arrhythmias such as atrial fibrillation may be related to atrial dilation secondary to valvular heart disease. Objective: This article describes the technical implications of pacemaker implantation in a patient with dextrocardia and a cardiac conduction disorder. Methods: A case report with a literature review is presented. Results: We report the case of an 84-year-old female patient who presented with syncope, atrial fibrillation with a slow ventricular response, and dextrocardia with situs inversus totalis. Implantation of a single-chamber pacemaker in VVIR mode was indicated. The procedure presented a medical and technical challenge due to the mirror-image anatomy and associated tricuspid regurgitation. The electrode was advanced into the right ventricle, Active fixation was necessary due to electrode instability caused by tricuspid regurgitation, using oblique fluoroscopic views to ensure correct placement in the interventricular septum. Conclusion: This case highlights the need to adapt device implantation techniques in the presence of complex anatomical variations, as well as the value of multimodal imaging tools for optimizing outcomes in patients with previously undiagnosed congenital heart disease.

Recibido: 06/11/2025

Abrobado: 04/02/2026