Left Ventricular Lead Placement with Over-the-Wire Technique for Right Ventricular Pacing in a Patient with Distorted Vessels

Vascular access can present a clinical challenge in the implantation of permanent pacemaker leads. We describe the case of an 81-year-old man with complete heart block in whom it was difficult to find a suitable vein for advancing a pacemaker lead. The left cephalic vein was selected for lead implantation; however, because of a 90° angle between the cephalic and axillary veins, the lead failed to advance. Because the patient was elderly and at high risk, we decided to place a left ventricular pacing lead in the right ventricle by means of an over-the-wire technique. After 1 month, the patient''s pacing threshold was good, and the lead remained in the right ventricular apex. When patients have distorted vessels and lead placement seems difficult or impossible, we think that the over-the-wire placement technique can be effective.Key words: Catheterization, central venous/methods; electrodes, implanted; pacemaker, artificial; punctures; treatment outcomeVascular access can present a clinical challenge in the implantation of permanent pacemaker leads. The subclavian, axillary, internal jugular, and cephalic veins are typically used for lead placement.¹ In most cases, access to these veins is easy and the leads are put into place without undue difficulty. However, particularly in elderly patients, insertion of the lead can be complicated because of distorted vessels. We describe a new method that we used to achieve lead placement in a patient with distorted vessels.