Introduction
The cardiac resynchronisation therapy–defibrillator (CRT-D) is an
established treatment for heart failure which reduces morbidity and
mortality (1). The pacing leads are predominantly implanted via the
transvenous approach, usually by subclavian or axillary puncture and
sometimes by cephalic vein cut-down. There is no standard approach, but
cephalic access is feasible, effective and safe (2)(3), irrespective of
the number of leads being implanted (4). Traditional lateral subclavian
vein puncture has been associated with a higher rate of lead failure
than the use of cephalic venous access (5)(6), but a recent report has
suggested that multi-lead defibrillator therapy utilising the cephalic
route is associated with early implantable cardioverter defibrillator
(ICD) lead failure (7).