Successful implantation of a dual-chamber permanent pacemaker in a patient with persistent left superior vena cava and absence of right superior vena cava: tips and tricks

An absent right superior vena cava associated with persistent left superior vena cava (PLSVC) is a rare and generally asymptomatic congenital malformation. It is usually discovered incidentally during pacemaker (PM) implantation. In this report, we describe our experience with implanting a dual-chamber pacemaker in a patient with such complex anatomy and the clinical value of peripheral phlebography for clearly describing venous anatomy in the surgical room. In particular, we highlight the methods used to ensure correct lead positioning.