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Subclavian Puncture for Pacemaker Lead Placement

In a recent issue of AnnaJs of Thoracic Surgery (Ann, Thorac. Surg,, 41:438, 1986) this editorialist published data concerning the implantation of dual chamber pacemakers via venous cutdown; it was concluded that such an approach allowed implantation of three-quarters of all dual chamber pacemakers which require both an atrial and a ventricular lead, without subclavian puncture and, presumably, would have allowed an even higher proportion of single chamber pacemaker implants. Venous access could be achieved without the risk of pneumothorax, hemothorax, and hembpneumothorax, all of which are significant and sonietimes even lethal complications. Since preparation of that manuscript I have become even more convinced that the difference between occasional serious complications and the absence of such complications is very significant.