Successful implantation of dual-chamber permanent pacemaker in case of persistent left superior vena cava with the absence of right superior vena cava

Persistent left superior vena cava (PLSVC), a rare congenital abnormality of the venous system, often goes unnoticed. Typically, it is identified incidentally while performing certain interventional procedures. It may manifest as sick sinus syndrome (SSS) or third-degree atrioventricular block, necessitating pacemaker implantation. This placement can be challenging since the dilated coronary sinus (CS) complicates locating the ventricular lead in certain circumstances. Here, the presented case focuses on a 55-year-old female presenting with SSS after complaining of presyncope, chest pain, and dizziness. The decision to implant a dual-chamber pacemaker was approved, but technical complications suggested a PLSVC with an absent right superior vena cava throughout the procedure. The particularity of this case was that, despite the anatomical difficulties, it was possible to cross the ventricular lead into the CS using a semicircular stylet.