© 2015 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved. A left pectoral dual chamber implantable cardioverter-defibrillator (ICD) was successfully implanted through a small branch communicating between a persistent left superior vena cava (PLSVC) and right-sided venous drainage with long sheaths. Postprocedural computed tomography identified the communicating branch. ICD lead implantation through a PLSVC is challenging and sometimes unsuccessful. This case illustrates an alternative approach for ICD lead implantation in patients with a PLSVC. A PLSVC system should be carefully inspected for any communicating branches that can be utilized for lead implantation in order to increase the chance of success and minimize the risk of complications.