Retroclavicular route for electrode placement in endocardial pacemakers.

In order to avoid skin erosion and electrode infection in endocardial pacemakers placed through the external jugular vein, we direct the wires from their point of entry into the vessel to the pacing unit placed in the pectoral region by dissecting a retroclavicular tunnel. This can be done under general or local anesthesia, and so far we have not seen any injuries to the subclavian vein. In this way the entire pathway of the cables is deep enough so that they cannot be palpated through the skin, and the dangers of exposure through erosion are minimized.