Persistent left superior vena cava (PLSVC) is an uncommon anomaly. We describe a case of a left-sided implantation of an implantable cardioverter defibrillator (ICD) through a PLSVC, assessing the technical approach to such a procedure, along with a review of the clinical implications that might ensue. Learning objectives: LSVC is a rare anatomical venous variation. Knowledge of its presence and clinical implications will render a lead implantation safer and will limit complications that might ensue.
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