Pectoral implantation of single-lead implantable cardioverter- defibrillators in patients without transvenous access

With the introduction of the single-lead 'Active-Can' implantable cardioverter-defibrillators, the implantation of the internal defibrillators has become a technically easy procedure. With these systems lowest defibrillation thresholds are achieved with a very low complication rate. For patients with thrombosis of both subclavian veins, however, a transvenous implantation technique is not possible. These patients are still equipped with epicardial patch electrodes. This article describes an alternative technique for implantation of this system in such patients, eliminating the need for epicardial patches and related complications.