A successful implantation of a dual-chambers cardioverter defibrillator for a patient with severe tortuous persistent left superior vena cava.

We report a case of successful implantation of a dual-chambers transvenous cardioverter defibrillator for a dilated cardiomyopathy patient with severe tortuous persistent left superior vena cava and a very small innominate vein. After confirming the presence of a right superior vena cava, a dilated sheath was advanced into the narrow innominate vein to increase the lumen of innominate vein. The active atrial and ventricular leads were successfully inserted into right atrium and right ventricle through innominate bridge by the support of steerable long sheaths.