Left-sided ICD implantation via right-sided venous access in a patient with left hemodialysis fistula.

A sufficient patency of the central vein ipsilateral to atriovenous fistula is the lifeline for hemodialysis patients. We describe a case with left dialysis fistula who underwent left-sided pectoral implantation of an implantable cardioverter defibrillator via right subclavicular venous access in order to avoid the possibility of development of left subclavian stenosis or occlusion and to achieve lower defibrillation thresholds. This approach may serve as an alternative choice in patients unsuitable for left-sided venous access and with higher defibrillation thresholds on right-positioned implantable cardioverter defibrillator.