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Complicated implant in a patient with suspected dextrocardia and persistence of upper left vena cava: physiological considerations and implant issue

Persistence of a left superior vena cava (PLSVC) has been reported in 0.3%–0.4% of candidates for pacemaker; another rare anomaly (incidence 8 / 100,000) is dextrocardia. We report the case of a 67-year old man, without any cardiological history, with prolonged episodes of bradycardia, secondary to a second degree type 1 and 2 block, and AV 2:1 block phases, which was placed the indication for a bicameral PM implantation. At the chest radiograph the radiologist suggested the presence of dextrocardia. During the pacemaker implantation procedure through the left subclavian venous access, the guide wire proceeded on an abnormal way, remaining in the left side of the chest. The angiography showed PLSVC. In this case, the complexity to the intervention was represented by dextroposition of the heart.