This report describes the case of a woman with Chagas' cardiomyopathy with severe left ventricular dysfunction and persistent left superior vena cava who presented with episodes of syncope without prodromes and who was referred for cardiac resynchronization therapy. Despite this venous anomaly, electrodes were safely positioned in suitable locations. (Level of Difficulty: Intermediate.) (J Am Coll Cardiol Case Rep 2019;1:387-90) © 2019 The Authors. Published by Elsevier on behalf of the

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... College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). HISTORY OF PRESENTATION A 71-year-old woman with Chagas' disease was referred for evaluation because of episodes of syncope with no prodromes. The electrocardiogram (ECG) showed a third-degree atrioventricular block. MEDICAL HISTORY Previous medical records revealed a left ventricular ejection fraction of 20% and a bifascicular block on ECG (right bundle block and a left anterior fascicular