Permanent pacemaker implantation in the absence of a right superior vena cava. A case report.

In a patient with syncope and sinus bradycardia the left superior vena cava drained into the right atrium via the coronary sinus. He underwent permanent transvenous pacemaker implantation via the tortuous left superior vena-caval route, and has continued to show normal pacing over an 18-month follow-up period. The problem of pre-operative recognition and the optimum means of permanent and temporary pacing in this condition are discussed.