Subclavian venogram as a guide to lead implantation

Recent reports have raised doubts regarding the safety and efficacy of the blind subclavian venipuncture technique for intracardiac lead implantation. To permit a more lateral entry, we used a simple subclavian venogram performed through the brachial vein of the ipsilateral arm of 22 consecutive unselected patients undergoing lead implantation (19 permanent pacemakers and 3 intracardiac defibrillators). A total of 35 leads were implanted (31 left pectoral and 4 right pectoral). Lead insertion by venogram technique was used successfully in all patients. Two inconsequential arterial punctures occurred. There were no pneumotheraces, infections, or other complications. Lateral placement should facilitate lead manipulation and minimize 'subclavian crush.' The method of ipsilateral venogram guided lead insertion appears to be safe and reliable and deserves consideration in patients who require permanent lead placement via the subclavian vein approach.