Permanent pacing from a left ventricular vein in a patient with persistentleft and absent right superior vena cava

Persistent left superior vena cava with coexisting absent right superior ve na cava is rare with less than 150 cases in the literature. Various techniq ues for pacemaker implantation have been described in this situation. Mie r eport a 40-year-old man with sinus and atrioventricular nodal dysfunction w ho underwent dual chamber pacemaker implantation. We elected to implant the ventricular electrode down a left ventricular branch of the coronary sinus and the lead is stable at 4-month follow-up.