Lead addition in a patient with bilateral subclavian vein occlusion

The need to add a new lead to a CIED system is not uncommon, either due to lead malfunction or system “upgrade”. Occlusion of the subclavian and/or superior vena cava may cause significant difficulty for the implanter by blocking access to the heart. Lead extraction provides the ability to create a new conduit, and thereby prevent the need for performing an epicardial lead placement or risking bilateral venous occlusions. This case discusses a patient with bilateral subclavian vein occlusions and need for a new dual chamber pacing system.