Upgrade of a pacemaker defibrillator to a biventricular device: the internal jugular vein approach in a case of bilateral subclavian veins occlusion.

Cardiac resynchronization improves survival and functional class of patients with advanced chronic heart failure. Placement of a stimulation electrode in the coronary sinus via the left subclavian vein is not always possible and other alternatives are required, above all when it concerns upgrading a previous device. This paper presents the case of a patient with a pacemaker/defibrillator and occlusion of both subclavian veins who had a stimulation electrode successfully placed in the coronary sinus via the right internal jugular.