“…Without direct access to the right-sided cardiac chambers through the vena cavae for temporary or permanent pacing, an unconventional approach should be considered and sought, as was shown in the present case. The LPPV is a vessel located on the lateral border of the heart which courses adjacent to the pericardium and drains into the left brachiocephalic vein ( 6 , 7 ). As its name implies, the LPPV courses within the left pericardiophrenic bundle, adjacent to the phrenic nerve ( 8 ), which led to phrenic nerve stimulation with pacing in this location.…”