Right-Sided Dual-Chamber Left Bundle Branch Area Pacing in Persistent Left Superior Vena Cava: A Case Report on Personalized Conduction System Pacing.

BACKGROUND: Persistent left superior vena cava (PLSVC) can complicate transvenous device implantation due to challenging venous anatomy and limited sheath support during physiologic pacing lead delivery. CASE SUMMARY: A woman in her mid-40s evaluated for a syncopal episode had ambulatory electrocardiography showing high-grade atrioventricular block with prolonged pauses, deemed irreversible, leading to plans for a permanent pacemaker. Intraprocedural venography identified a PLSVC. A right-sided dual chamber left bundle branch area pacing (LBBAP) was successfully performed. The procedure was uncomplicated, and follow-up with cardiology was arranged. DISCUSSION: Right-sided LBBAP can be feasible and associated with positive outcomes in patients with PLSVC, and it should be considered a strong option when traditional venous routes are difficult. Early detection and adaptable pacing strategies are essential for maximizing outcomes in such patients.