A challenging dual chamber permanent pacemaker implantation in persistent left superior vena cava with absent right superior vena cava.

An isolated persistent left superior vena cava (PLSVC) with absent right superior vena cava is a rare and generally asymptomatic congenital malformation. It is usually discovered incidentally during a pacemaker implantation or electrophysiological procedures. We report an adult male who underwent successful dual chamber permanent pacemaker implantation through left subclavian approach with a 7-year follow-up showing a still appropriate function of the device. We discuss the technical issues and solutions to overcome such technical difficulties.