title: Permanent transfemoral pacemaker implantation is the technique of choice for patients in whom the superior vena cava is inaccessible.
abstract: We describe transfemoral pacemaker implantation in three patients in whom pacing via the superior vena cava was not possible or suboptimal. The first was an 88-year-old man with superior vena cava obstruction presenting with fractured epicardial pacing leads. Recent pneumonia increased the risks of a general anesthetic. The second patient was a 57-year-old man who was intolerant of a pectorally sited pacemaker because of the thinness of his anterior chest wall. The third patient was a 69-year-old woman who presented with an infected eroding pectorally sited pacemaker. Scarring secondary to a previous pacemaker infection rendered the contralateral pectoral site inaccessible. Since the subclavian route was inaccessible (case 1) or suboptimal (case 2 and 3), we implanted transvenous pacemakers via the femoral route, which was safe, and effective, during a 6-month follow-up period.
authors.affiliation: Department of Cardiology, London Chest Hospital, United Kingdom. K.barakat@mds.qmw.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Barakat
authors.forename: J
authors.initials: J
authors.lastname: Hill
authors.forename: P
authors.initials: P
authors.lastname: Kelly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral / Q000379:methods*; D000075202:Contraindications; D004562:Electrocardiography; D005260:Female; D005268:Femoral Vein; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013479:Superior Vena Cava Syndrome / Q000150:complications / Q000000981:diagnostic imaging; D014683:Vena Cava, Superior