Challenges in lead position and stability of single entry through cephalic route by sheathless technique in dual chamber pacemaker implantation

Abstract

The axillary/subclavian venous approach has a potential for complication as inadvertent damage by the exploring needle to the structures nearby to the vein may cause significant complications. On the other hand, the greatest benefit of the cephalic approach – the risk of pneumothorax is nil and the risk of long-term lead failure due to crush injury through the subclavius muscle/ligament is also eliminated. Although multiple leads can often be placed via the cephalic vein, however the occasional difficulty in inserting two leads into cephalic vein may limit opportunity of using this approach for dual lead system in some patients. Here we report a case where two leads were implanted directly through single entry into cephalic vein without aid of any sheath and procedure was successfully completed during dual chamber pacemaker implantation.