Contralateral transvenous left ventricular lead placement of an implantable device with pre-sternal tunneling in an ipsilateral chronically obstructed subclavian vein.

Multiple methods are used to tackle ipsilateral obstructed venous access in patients undergoing a device upgrade by implanting a new left ventricular lead. One feasible solution to tackle this is implantation of the upgrade lead contralaterally with pre-sternal tunnelization to the opposite side under conscious sedation.