Chronic lung collapse: a predictable impediment to ipsilateral lead placement

Implantation of a permanent transvenous pacemaker was undertaken in a patient with longstanding, complete collapse of the right lung. Unanticipated distortion of the lead path prevented entirely introduction of a right subclavian sheath and rendered lead placement from a right cephalic venotomy extremely difficult. An angioplasty guidewire substituted for the standard stylets proved useful in positioning the lead. This report describes the predictable venous deformity, illustrates the consequent impediment to ipsilateral lead placement, and discusses why contralateral entry sites should be superior in cases of massive loss of lung volume.