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.


CONCLUSIONS
Pacing through the right supraclavicular subclavian vein route is a safe and reliable alternative in cases where access through the infraclavicular route is difficult.
Liu
Kun-Shen
KS
The First Hospital of the Hebei Medical College, Shijiazhuang City, PR China. ksliu@inhe.net
Liu
Chao
C
Xia
Yue
Y
Li
Yan-Hui
YH
Du
Wei
W
Wei
Qing-Min
QM
Zhao
Wei-Jiang
WJ
D003422:Critical Care; D004567:Electrodes, Implanted; D019544:Equipment Failure Analysis; D005500:Follow-Up Studies; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010138:Pacemaker, Artificial; D018962:Phlebotomy / Q000379:methods*; D011474:Prosthesis Design; D013350:Subclavian Vein