Persistent Left Superior Vena Cava: Unanticipated Stumbling Block in Cardiac Resynchronization Therapy

Persistent left superior vena cava (PLSVC) is a relatively rare anatomical anomaly, with a higher prevalence in those with congenital heart defects. While typically asymptomatic, its presence can complicate certain medical procedures, particularly cardiac interventions, such as the implantation of cardiac resynchronization therapy (CRT) devices, due to acute angulation. In this report, we discuss the challenges posed by the unanticipated presence of PLSVC during CRT device implantation and describe the technique used for lead placement using Judkins Right catheter for support, placing coronary wire, and later placing the left ventricle (LV) lead with the help of buddy wire technique, resulting in successful insertion of all three CRT leads despite the anatomical challenges.