Permanent pacing through a persistent left superior vena cava: an approach and report of dual-chambered lead placement.

The patient with a persistent left superior vena cava who requires permanent pacing presents difficulties if no right superior vena cava is present or if it is encountered unexpectedly at pacemaker implantation. A case is presented that illustrates potential problems and suggests a general approach to this situation. Successful transvenous universal pacemaker insertion through a persistent left superior vena cava is reported.