Successful dual chamber ICD implantation via a persistent left superior vena cava after ratchet syndrome.

Device implantations may be challenging in patients with venous abnormalities. The most common congenital variation, frequently associated with other congenital abnormalities, is a persistent left superior vena cava (PLSVC), and successful atrial and ventricular lead implantation via a PLSVC have both been reported [1]. “Ratchet syndrome” has also been reported as a rare complication after a newly implanted pacemaker or implantable cardioverter-defibrillator (ICD) and involves lead dislodgement and retraction due to a ratchet-like movement through the suture sleeve that causes a continuous short pull [2], [3]. Here, we present a rare case in which successful dual-chamber ICD implantation via a PLSVC was achieved after the occurrence of ratchet syndrome.