Pacemaker implantation in persistent left superior venacava with absent right superior venacava: Lessons learnt

A 55 year old male presented to us with history of recurrent episodes of syncope following which he was detected to have sick sinus syndrome and was planned for a permanent pacemaker implantation. During the procedure he was incidentally detected to have a persistent left superior venacava with absent right superior venacava as probably his initial echocardiogram was overlooked and the procedure was replanned to a later date. A 64 slice MDCT scan was done to delineate the venacaval and great arterial relationship which confirmed a persistent left superior venacava with absent right superior venacava. We planned to proceed with a permanent pacemaker implantation (VVI) with active fixation through the left subclavian vein following which he had a lead dislodgement on the 7th post procedure day. The pacemaker lead was later repositioned in a more stable position with a smaller loop and he is doing well on follow up. Permanent pacemaker implantation through a persistent left superior venacava is a technically challenging procedure and prone for complications and hence the importance of this case.