The prevalence of persistent left superior vena cava (PLSVC) in the general population has been estimated to be approximately 0.3%, as determined by autopsy. PLSVC is hemodynamically insignificant if it is not associated with other congenital cardiac anomalies, and usually goes unrecognized until a left superior approach to the heart is required. Here, we report a 60-year-old male diagnosed with dilated cardiomyopathy, who had survived an episode of sudden cardiac arrest with documented ventricular fibrillation. PLSVC was recognized incidentally while implanting an implantable cardioverter-defibrillator (ICD). The ICD was successfully implanted through the left superior vena cava via the coronary sinus using a straight stylet and an active fixation device.