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 imp lantation. To permit a more lateral entry, we used a simple subclavian venogram performed through the brachial vein of the ipsilateral arm o f 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 in sertion by venogram technique was used successfully in all patients. T wo inconsequential arterial punctures occurred. There were no pneumoth oraces, infections, or other complications. Lateral placement should f acilitate lead manipulation and minimize ''subclavian crush.'' The met hod of ipsilateral venogram guided lead insertion appears to be safe a nd reliable and deserves consideration in patients who require permane nt lead placement via the subclavian vein approach.