Implant of a biventricular pacemaker in a patient with dextrocardia and persistent left superior vena cava.

Congenital anomalies of the heart can pose challenges to cardiac invasive procedures. Here, we present the case of a 40-year-old man with the combination of dextrocardia, a persistent left superior vena cava, and idiopathic dilated cardiomyopathy. We describe the successful implantation of a biventricular pacemaker-defibrillator under this complex anatomic condition.