Persistent Left Superior Vena Cava (PLSVC) is a rare congenital anomaly which is typically asymptomatic and discovered incidentally during device implantation. Methods: In this case, we present challenges and techniques of Cardiac Resynchronization Therapy (CRT) in a patient with PLSVC. Results: After evaluating the exact anatomy of PLSVC and Coronary Sinus (CS), we chose the appropriate approach and equipment's. By using a J shaped stylet, a guide wire and inner sub-selection catheter, we

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... rmed implantation successfully. Conclusion: In most cases of PLSVC, successful cardiac device implantation is possible with increasing operator experience, cardiac imaging and appropriate tools.