Nontraditional Surgical Approaches for Implantation of Pacemaker and Cardioverter Defibrillator Systems in Patients With Limited Venous Access

Conventional transvenous lead implantation may be difficult or impossible in some patients with aberrant or occluded venous access. Novel surgical approaches with the use of minimally invasive procedures can establish optimally functional pacing and ICD systems without sternotomy and low associated morbidity.