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The persistence of the left superior vena cava is a congenital anomaly most often associated with an abnormality of venous return, usually asymptomatic and fortuitous discovery. It can pose technical difficulties during cardiac pacing. We report the case of a pacemaker lead path abnormality related to persistence of the left superior vena cava in a 68-year-old patient. She was admitted to our unit for a symptomatic complete atrioventricular block with of vertigo. During the procedure, the progression of the lead through the left subclavian vein was slowed down by an obstacle. The lead presented an aberrant path with an early descent ahead of the aortic button and a defect of progression after product injection. Post-stimulation echocardiography revealed coronary sinus dilatation. Chest CTA had confirmed the left superior vena cava with a vertical pre-aortic seat and thrown into the right atrium. The pacemaker was finally implanted by right subclavian way successfully.