A technique for the insertion of an intracardiac electrode through the subclavian vein and implanting the generator in the axilla for permanent endocardia1 pacing is described in 30 patients. Provided that adequate precautions are taken and the procedure is carried out by experienced personnel, complications are uncommon.The generator is implanted after the pacing threshold has been found to be satisfactorily stable. Drainage is not used and routine antibiotics are not given to any patient unless secondary infection of the wound complicates the procedure. Advantages of this technique over the other conventional methods are described.TRANSVENOUS intracardiac pacing has become an established therapeutic measure in the treatment of complete heart block causing Stokes-Adams attacks and congestive cardiac failure (Siddons and Sowton, 1968), in sinus node disease (Reid et al., 1973) and in some cardiac dysrhythmias (Sowton, 1968). At present more than 1800 patients in Britain have implantable mercury-cell pacemakers (Leading Article, 1971). The femoral, cubital, cephalic, external jugular and subclavian veins have been used to introduce the pacing catheter. Each route has its limitations and it is the purpose of this paper to describe the method and value of using the subclavian vein.
Patients and methodsPermanent transvenous intracardiac pacing was carried out in 30 consecutive patients suffering from Stokes-Adams attacks due to complete heart block. The age of the patients varied from 46 to 88 years (18 males and 12 females). The pacing catheter was introduced through the subclavian vein by a percutaneous technique and the pacemaker was implanted in the axilla. Postoperative follow-up studies range from 18 to 47 months. The method of venepuncture and the procedure of implantation are described below.