Article Text

Permanent pacing in patients without upper limb venous access: a review of current techniques
  1. Swee-Chong Seow,
  2. Toon-Wei Lim,
  3. Devinder Singh,
  4. Wee-Tiong Yeo,
  5. Pipin Kojodjojo
  1. Cardiology Department, National University Heart Centre, Singapore, Singapore
  1. Correspondence to Dr Swee-Chong Seow, Cardiology Department, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, 119228 Singapore, Singapore; swee_chong_seow{at}


Permanent transvenous cardiac pacing is usually accomplished through the upper limb veins. When these are occluded, several other vascular access options exist which include the internal jugular, external jugular, femoral and iliac veins as well as more proximal access of the subclavian veins. Anterograde and retrograde techniques to restore subclavian venous patency has been described. A review of these approaches is undertaken, with a discussion of their pros and cons. Familiarity with these techniques will enable the implanter to perform transvenous pacing when faced with limited vascular access.

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