Inferior vena cava approach to permanent pacemaker implantation.

A 89-year-old woman required permanent pacemaker implantation because of symptomatic bradyarrhythmia with multiple falls and repeated fractures. Because of the obstruction of the thoracic veins and infection of both groins, an alternative approach via directly punctured inferior vena cava was performed. At follow-up, the patient remained well with an excellent symptomatic response to pacing. The method seems simple to perform and is an alternative when the usual pectoral implantation site is inaccessible.