Total occlusion of the left subclavian vein was diagnosed in a 76-year-old
patient, 6 years after implantation of an ICD with VVI pacing backup. Repla
cement of the ICD included upgrading of the ICD system because of the prese
nce of pacemaker syndrome when he patient was WI paced. Insertion of an atr
ial lead through the ipsilateral vein system was made possible by using the
supraclavicular approach of the subclavian, enabling puncturing of the lef
t subclavian vein medially to the obstruction.