# Contralateral transvenous left ventricular lead placement of an implantable device with pre‐sternal tunneling in an ipsilateral chronically obstructed subclavian vein

## TL;DR

A new method is described for placing a heart device lead when a vein is blocked, using the opposite side and a tunneling technique.

## Contribution

A novel approach for left ventricular lead placement in patients with obstructed subclavian veins is proposed.

## Key findings

- Contralateral lead placement with pre-sternal tunneling is a feasible solution for obstructed venous access.
- The procedure can be performed under conscious sedation, avoiding more invasive techniques.

## Abstract

Multiple methods are used to tackle ipsilateral obstructed venous access in patients undergoing a device upgrade by implanting a new left ventricular lead. One feasible solution to tackle this is implantation of the upgrade lead contralaterally with pre‐sternal tunnelization to the opposite side under conscious sedation.