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A 48-year-old woman presented with recurrent syncope. She had a modified radical mastectomy for breast cancer on the right side. ECG revealed a complete heart block. Permanent pacing was planned from the left side. We saw an unusual course of the pacing lead (figure 1 and online supplementary video). A venogram showed the left-sided superior vena cava (SVC) draining into the right atrium. It was difficult to negotiate the lead from the right atrium to the right ventricle. We made a 360° loop of the stylet like the tail of a pig. The pacing lead then entered the right ventricle easily. The patient has been …
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