Upper body venous access for transvenous lead placement--review of existent techniques.

Recent developments in permanent pacemaker and implantable cardioverter-defibrillator therapy have focused on the endocardial placement sites of leads ("selective site pacing"), detection and pacing algorithms, and indications for device therapy. In comparison, the surgical and venous access aspects of device therapy have received relatively little attention. Obtaining central venous access is a prerequisite for delivering device therapy through transvenously placed leads. This article reviews the different techniques available for obtaining upper body venous access for transvenous lead placement, even though the information will also be relevant to other specialties that require central venous access for other purposes.