Permanent transvenous pacemaker implantation via the subclavian vein

Permanent transvenous pacing with the use of a subclavian venipuncture technique was achieved in 68 patients, including 3 children. In two additional patients the subclavian vein could not be entered. The basic procedure is a modification of the Seldinger technique and involves the use of a peel-away introducer. Complications directly related to the procedure occurred in three cases. These included two pneumothoraces and one wound hematoma following puncture of the subclavian artery. All three patients were managed conservatively, without drainage. The major advantages of the subclavian venipuncture technique are that it avoids extensive dissection and provides rapid access to the right ventricle via a large-caliber vessel, it allows placement of multiple catheters for atrioventricular systems, and it allows the use of transvenous systems in children.