Persistent left superior vena is a relatively rare congenital variant. It is, however, the most common variation of the thoracic venous system. Prevalence is estimated in about 0.6 to 1.0% during ...pacemaker placement. This finding, often incidental, can difficult the lead progression through the left jugular or subclavian routes. This report describes a case of successful pacemaker implantation through a persistent left superior vena. Technical difficulties were overcome using the pacemaker electrode as unipolar lead. Endocavitary ECG recording helped us to guide the lead through the tortuous anatomy. A stable lead position was finally achieved by means of the active fixation system of the pacemaker electrode.
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