Left persisting, singular superior vena cava and pacemaker electrode implantation by right cephalic vein

We are reporting on a case of a singular left upper vena cava with an outlet into the right atrium by a large sinus coronarius (that means, the right vena cava is lacking totally). In spite of the well-known anomaly of the upper vena cava, we successfully implanted a stimulating electrode by the typical access through the right vena cephalica through the right sinus coronarius into the right ventricle. Except of a thrombosis of the rightsided deep venous system of the arm, no complications were to be complained within sixteen months. We know from literature, that within four more cases this transvenous access has been used in pacemaker-therapy. Various complications have been discussed. Before definately implanting an electrode, one should secure severely, if there is any special anomaly of the upper vena cava. In case of the here described, but very rare anomaly of the vana cava, it is to be examined thoroughly, whether an implantation of a transvenous electrode is indicated or, eventually, a myocardial implantation should be preferred.