A 55-year-old lady came with recurrent syncope due to complete heart block. A temporary pacing lead could not be advanced via the inferior vena cava (IVC) to the right atrium. A venogram demonstrated that the IVC had no connection to the right atrium. The temporary lead could then be advanced through the azygos and superior caval vein to the right atrium and ventricle. The patient had no congenital heart disease or visceral heterotaxy.
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