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"A persistent Left Superior Vena Cava (LSVC), especially with an absent Right Superior Vena Cava (RSVC), is a rare finding during pacemaker implantation and is accompanied by technical difficulties" Alemzadeh-Ansari et al (2013).
Abstract:

Vascular access has remained a major challenge for implantation of permanent pacemaker leads. A persistent Left Superior Vena Cava (LSVC), especially with an absent Right Superior Vena Cava (RSVC), is a rare finding during pacemaker implantation and is accompanied by technical difficulties. Herein, we describe a case of sinoatrial node arrest, in which finding a suitable vein for passing the lead was challenging. The patient had a persistent LSVC with an absent RSVC.

Reference:

Alemzadeh-Ansari, M.J., Shafiee, A. and Yaminisharif, A. (2013) Implantation of Transvenous Permanent Pacemaker in a Patient with Persistent Left Superior Vena Cava and Absent Right Superior Vena Cava. International Cardiovascular Research Journal. 7(4), p.152–154.

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