Permanent pacemaker implantation in a patient with persistent left superior vena cava with an absent right superior...

Persistent left superior vena cava (PLSVC) is a common congenital anomaly of the thoracic venous system. PLSVC affects 0.3-0.5% of the general population, with 0.09-0.13% having PLSVC with an absent right superior vena cava. A 92-year-old woman was transported to our hospital by ambulance because of syncopal attacks lasting a few seconds. Electrocardiography showed paroxysmal supraventricular tachycardia and sinus arrest for up to 10 s with syncope when the arrhythmia stopped. This occurred repeatedly, and a diagnosis of sick sinus syndrome was made. The patient was scheduled for dual-chamber permanent pacemaker implantation. She had isolated PLSVC, and pacing lead was inserted into the right atrium through the PLSVC from her left subclavian vein. The "J" pre-shaped stylet was used to introduce the lead via the tricuspid valve to the right ventricular outflow tract (RVOT) and placed in the septum of RVOT. Another lead was advanced into the right atrial appendage using the "J" pre-shaped stylet. After three years of implantation, fluoroscopy showed a stable position of pacing leads, and pacemaker interrogations showed no major changes in parameters. <Learning objective: Persistent left superior vena cava (PLSVC) is a common anomaly of the thoracic venous system. PLSVC is either isolated or associated with an absent right superior vena cava and a connection with the left atrium creating a shunt. In isolated PLSVC and PLSVC with an absent right superior vena cava, implantation of a permanent pacemaker is difficult but possible using conventional devices.>.