Persistent left superior vena cava (LSVC) is a rare congenital anomaly which can add difficulties in placing defibrillation leads and achieving good defibrillation thresholds. Previous reports described placement of leads at or near the right ventricular apex. We hereby report the first case of a dual-coil, active fixation defibrillation lead, successfully implanted into the anterior-septal right ventricular outflow tract, through a persistent LSVC.