Endocavitary implantation of a permanent pacemaker in the contralateral side of right pneumonectomy: a case report

The definitive endocardial stimulation is easy to install, allows a stable position of the leads, and a satisfactory stimulation thresholds for a long period. The epicardial approach is reserved for some rare indications including infectious contexts. The endocardial approach has been considered for a 67 years man with a complete AV block and an atrial fibrillation. This patient had undergone a right pneumonectomy 15 years before. A VVIR pacemaker has been implanted successfully by an internal jugular vein approach, and connected to a passively fixed unipolar lead. Because of the right ventricle deformation which made it unrecognizable, even by angiography means, we had to face major difficulties to position the lead. The epicardial approach should be considered even if a direct unique lung controlateral approach is easier than homolateral, because it allows us a quick ventricular access under the view control.