Dual Chamber Pacing via a Persistent Left-Sided Superior Vena Cava

Congenital anomalies of superior vena cava (SVC) can complicate the placement of
transvenous pacemaker leads. Persistent left SVC (PLSVC) is the most common congenital anomaly of SVC. In this paper, we describe the case of a 72-year-old male patient who presented with complete heart block and PLSVC. The anomaly was verified by venography. Atrial (passive fixation) and ventricular (screw-in) leads were passed down the PLSVC and coronary sinus (CS) and the tips were positioned in the right atrial appendage and right ventricular apex, respectively. Follow-up of the patient revealed good pacing and sensing thresholds with stable lead positions. Venography and long, active fixation leads can help overcome the technical problems of PPM implantation in these patients