A 71-year-old woman with Turner's syndrome underwent pacemaker implantation for complete atrio-ventricular block. During the procedure, the persistence of left sided superior vena cava (LSVC) was observed such that the lead, through the coronary sinus, reached the right atrium. By use of stylets, we could drive the lead against the lateral atrial wall and curve it through the tricuspid valve into the right ventricle. The tip reached an apical stable position, obtaining proper stimulation values. Moreover, the VDD dipole was positioned against high lateral atrial wall, adequately sensing the atrial potential. So, we could obtain an atrial synchronous ventricular pacing with only one VDD lead.
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