Troubleshooting during pacemaker implant in persistent left superior vena cava with absence of right superior vena cava (isolated persistent left superior vena cava)

Persistent left superior vena cava (PLSVC) with absence of right SVC (isolated PLSVC) is a rare congenital anomaly that occurs as a result of a degenerative condition in the left anterior cardinal vein. It is generally an incidental finding while performing invasive procedures such as antiarrhythmic device implantation. We report on a rare case of permanent pacemaker implantation in a patient with this anomaly from right subclavian route, albeit most of the earlier reported cases are from left subclavian approach. A wide spectrum of clinicians should be aware of this anomaly, its variations, and possible complications.