Implantation of permanent transvenous pacemaker via subclavian vein

A favorable overall experience was found with permanent transvenous cardiac pacing using a direct venipuncture for entry into the subclavian vein. The method allows a rapid and relatively atraumatic introduction of a variety of transvenous pacemaker electrodes. However, a fatal complication developed that was caused by unrecognized puncture of the left pulmonary artery in an elderly patient. This was the result of a technical error and emphasizes that experience in subclavian venipuncture is essential to avoid the complications of this approach.