Safe introducer technique for pacemaker lead implantation.

Over the last several years, an introducer approach for pacemaker lead insertion has evolved that eliminates most introducer-related complications. The approach consists of defining a safe region for intrathoracic cannulation of the subclavian vein. If specific conditions cannot be met for entering the "safe" region or if the vein cannot be found, the subclavian vein is cannulated extrathoracically. Recently, this technique was used in 263 consecutive patients undergoing pacemaker implantation. The intrathoracic portion of the subclavian vein was used in 239 (90.9%) cases and the extrathoracic portion in 24 (9.1%). One hundred and ninety-eight (75.3%) cases were right-sided and 65 (24.7%) were left-sided. On the right side, 177 (89.4%) used the intrathoracic portion of the subclavian vein and 21 (10.6%) used the extrathoracic portion. On the left side, 62 (95.4%) used the intrathoracic portion and three (4.6%) used the extrathoracic. The introducer technique was successful in all cases and there were no introducer-related complications.