Dextrocardia is a rare congenital anomaly, whereas its association with sick sinus syndrome in young adults without accompanying heart abnormalities is exceptional. We report a case of a 38 year old female patient who was admitted to our hospital due to syncope as a consequence of sinus pauses up to 4.9 seconds. She was also diagnosed with situs inversus totalis, with mirror image dextrocardia. Pacemaker implantation was indicated. Under local anesthesia, from the left subclavian vein, the guide wire was passed through superior vena cava to the right atrium and ventricle without any obstacles. In conclusion, situs inversus totalis with mirror image dextrocardia may present in combination with sick sinus syndrome as early as the fourth decade of life. Implantation of pacemaker leads from the left subclavian vein appears accessible and safe in patients with dextrocardia with situs inversus (mirror image).