Right ventricle (RV) perforation is a complication that may arise during device implants. We present the case of a patient undergoing cardiac resynchronisation therapy upgrade that was complicated with an RV perforation. The lead was successfully repositioned with a good final outcome. Despite being uncommon, persistence of the left superior vena cava is the most frequent venous cardiac anomaly and may pose challenges during the implant procedure, namely when the right superior vena cava (RSVC) is absent. Still, in this patient it was not related to the event, as the leads were advanced through the RSVC.