Permanent Pacemaker for Sick Sinus Syndrome with Absent Right Superior Vena Cava – A Case Report.

A 42 year old patient, admitted into our hospital for permanent implantation. Implantation of a permanent pacemaker was attempted by the transvenous approach via venous puncture of cephalic vein & subclavian vein on both sides but guide wire failed to pass. Coronary angiogram with cardiac catheterization was done & revealed absence of right superior vena cava and presence of persistant left superior vena cava. Under endotracheal general anesthesia (GA) with limited left thoracotomy epicardial pacemaker was implanted.