Permanent cardiac pacing through the right supraclavicular subclavian vein approach.

BACKGROUND: The infraclavicular subclavian route is commonly used for insertion of permanent pacing leads. However, the subclavian vein route may at times be a very difficult way to gain access to the heart. OBJECTIVE: To explore a new route to reliably and safely insert pacing leads. METHODS: The right supraclavicular subclavian vein route was selected to implant permanent leads in patients with critical illness or in situations where access through the infraclavicular approach was difficult. Access was achieved by Yoffa's venipuncture technique. A subcutaneous arc tunnel was made to pull the leads over the clavicle, which first arched close to the sternoclavicular joint and then curved to the inlet of the leads. The pacemaker was implanted in a right infraclavicular surgical pocket. RESULTS: This technique was used in 44 patients. The venipuncture time of 4.4+/-1.2 min was faster with the supraclavicular route than with the infraclavicular route. However, there was slightly more blood loss with the supraclavicular route. Total duration of implantation was similar for both routes (supraclavicular route 72+/-16 min and infraclavicular route 75+/-20 min). Lead dislodgement, lead fracture and skin erosion did not occur. CONCLUSION: Pacing through the right supraclavicular subclavian vein route is a safe and reliable alternative in cases where access through the infraclavicular route is difficult.