Safe and efficient emergency transvenous ventricular pacing via the right supraclavicular route

Infraclavicular and internal jugular central venous access are techniques c ommonly used for temporary transvenous pacing. However, the procedure still has a considerable complication rate, with a high risk/benefit ratio becau se of insertion difficulties and pacemaker malfunction. To enlarge the spec trum of alternative access sites, we prospectively evaluated the right supr aclavicular route to the subclavian/innominate vein for emergency ventricul ar pacing with a transvenous flow-directed pacemaker as a bedside procedure . For 19 mo, 17 consecutive patients with symptomatic bradycardia, cardiac arrest, or torsade de pointes requiring immediate bedside transvenous pacin g were enrolled in the study. The success rate, insertional complications, pacemaker performance, and patients' outcomes were recorded. Supraclavicula r venipuncture was successful in all patients, in 16 of 17 at the first att empt. Adequate ventricular pacing was achieved within 1 to 5 min (median, 2 min) after venipuncture and within 10 s to 4 min (median, 30 s) after lead insertion (less than or equal to 30 s in 15 of 17 patients). The median pa cing threshold was 1 mA (range, 0.7 to 2.5 mA). No procedure-related compli cations were recorded. Throughout the pacing period of 1538 h (median: 62 h , range, 1-280 h) two reversible malfunctions caused by inadvertent lead di slodgement after 122 and 171 h were recorded; in one patient the pacemaker had to be removed because of local infection after 14 days of pacing, We co nclude that the right supraclavicular route is an easy, safe, and effective first approach for transvenous ventricular pacing and might provide a usef ul alternative to traditional puncture sites, el en in a preclinical settin g. Implications: Temporary transvenous cardiac pacing can field high compli cation rates especially under emergency conditions. We investigated emergen cy pacing via the right supraclavicular access in 17 consecutive hemodynami cally compromised patients and found good safety; efficacy, and a low compl ication rate.