Transvenous pacing in presence of anomalous venous return to heart.

The majority of patients requiring pacemakers are paced using a transvenous electrode. Difficulties may be encountered in passing the electrode wire into the heart because of anomalous venous return. Probably the most frequent anomaly is a persistent left superior vena cava and the rarest is absence of the right superior vena cava (Winter, 1954; Hudson, I965; Sherman, I963). Recent case reports by Harthorne, Dinsmore, and Desantis (I969) and Kukral (I97I) ' have recorded failure to establish permanent transvenous pacing in patients with absence of the right superior vena cava and a persistent left superior vena cava communicating with the right atrium via the coronary sinus. We have recently installed a permanent transvenous pacing system in a patient with a superior s vena cava anomaly and we report the clinical and practical details.