Electrode instability and displacement have been reported in patients who underwent pacemaker implantation via persistent left superior vena cava. An active-fixation system, and sometimes epicardial pacing, is necessary to maintain pacing stability. We report the case of a 76-year-old man with a left superior vena cava who required dual-chamber permanent pacing. Passive-fixation atrial and ventricular leads were successfully inserted and produced good long-term pacing and sensing. To the best of our knowledge, this is the first reported case of implantation of a dual-chamber pacemaker via persistent left superior vena cava in Taiwan.