Background: Persistent left superior vena cava is the most common thoracic venous anomaly. It is usually asymptomatic, but it can make it difficult to implant intracardiac devices . Case presentation: We present a novel technique to facilitate right ventricular lead implantation in two patients with persistent left superior vena cava and the absence of the right superior vena cava. We used a fixed-curve Selectra 3D sheath (Biotronik), orienting the sheath towards the tricuspid valve by rotating it in a counter-clockwise direction. During follow-up, the electrodes remained stable. Discussion: Our technique was safe, simple and feasible for patients with this complex venous anatomy.