Venous puncture in permanent pacemakers implantation, when easy become difficult


  • Shahab Saidullah Assistant professor Pakistan institute of medical sciences, Islamabad
  • Bakhtawar Shah Senior medical officer Hayatabad medical complex Peshawar
  • Muhammad Aamer Niaz consultant cardiologist Ali medical Centre Islamabad
  • Muhammad Shoaib Registrar Pakistan institute of medical sciences Islamabad



Permanent Pace Maker, Venous Puncture, Axillary Vein, Seldinger Technique


Objective: To share our experience in the field of device implantation with particular emphasis on the venous punctures.
Methodology: This study was conducted in Cardiology Department at Hayat Abad Medical Complex Peshawar. All those patients who presented to Cardiology department Hayat Abad Medical Complex Peshawar for implantation of permanent pacemakers due to any reason were brought to catheterization laboratory after explaining the procedure. Chest scrubbed and draped and after venogram of the desired side axillary vein was punctured by Seldinger technique and if there was failure to puncture the vein after a few attempts, the position of the vein reconfirmed with venogram and reattempted. In few cases vein used to change its path after the initial failed attempts. After venous access skin incision was made superolateral to the puncture side, pocket constructed and lead position and pulse generator attached and wound closed in layers.
Results: A total of 484 pacemakers were implanted in the study period. Dual chamber pacemakers were 136 (28.09%) and single chamber pacemakers were 348 (71.90%). There were left sided persistent SVC in 2 cases and totally obstructed vein on both side in one patient. Procedure was shifted to right side in 10 patients due to unsuitable veins on left side. Vein change its tract in 07 cases.
Conclusion: Sound anatomical understanding venous course is crucial for safe venous puncture and successful PPM implantation.





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