نبذة مختصرة : Objective: Persistent left superior vena cava (PLSVC) is not uncommon venous return anomaly (0.3-05% of the general population). It is usually asymptomatic but can complicate transvenous cardiac interventions, particularly implantations of cardiac pacemakers. We present a case of need for pacemaker implantation in a patients with PLSVC. Case presentation: An 84-year-old woman was referred to hospital with frequent syncopal episodes, dizziness, and fatigue. Electrocardiogram showed atrial fibrillation with bradycardia (35-40 bpm). The patient was fully investigated and was qualified for permanent single-chamber pacemaker implantation. The patient had an isolated PLSVC. Additionally, she had right breast cancer; therefore we performed left axillary access for pacemaker implantation. The pacing lead was inserted via left axillary vein through the PLSVC to the coronary sinus. Afterwards, we looped lead in the right atrium, which helped us to put it through the tricuspid valve and implant the lead in apex of right ventricle. All lead measurements at implantation were acceptable. The patient was discharged three days post-implantation without any complications. In a 1-year follow-up we have noticed good lead parameters at interrogation and stable lead position on the X-ray. Conclusion: Certainly, clinicians must be aware of this anomaly and the challenges it presents during pacemaker implantation in affected patients, as well as potential solutions to address these challenges.
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