Use of the contralateral subclavian vein for placement of atrial electrodes in chronically VVI paced patients.

Two patients with documented pacemaker syndrome were referred for AV sequential pacing and were found to have inaccessible venous systems on the side of their original transvenous pacemaker placement. The contralateral subclavian vein was subsequently catheterized with an atrial electrode using the sheath-set technique. Then the proximal aspect of the atrial endocardial lead was tunneled to the original pacemaker pocket. Once accomplished, both (atrial and ventricular) leads were connected to an AV sequential pulse generator. The united pulse generator and lead were reinserted in the original pacemaker pocket.